Abstract
BACKGROUND: Acute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, to improve specificity in this population (sRAI). Here, we prospectively assess sRAI performance in a separate cohort. METHODS: A secondary analysis of a prospective, multicenter, observational study of children with septic shock admitted to the pediatric intensive care unit from 1/2019 to 12/2022. The primary outcome was severe AKI (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI), and we compared predictive performance of the sRAI (calculated on Day 1) to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). Original renal angina fulfillment (RAI +) was defined as RAI ≥ 8; sepsis renal angina fulfillment (sRAI +) was defined as RAI ≥ 20 or RAI 8 to < 20 with platelets >< 150 × 103 µl. results: among 363 patients, 79 (22%) developed d3 severe aki. one hundred forty (39%) were srai + , 195 (54%) rai + , and 253 (70%) d1 scr > Baseline + . Compared to sRAI-, sRAI + had higher risk of D3 severe AKI (RR 8.9, 95%CI 5-16, p < 0.001), kidney replacement therapy (krt) (rr 18, 95%ci 6.6-49, p >< 0.001), and mortality (rr 2.5, 95%ci 1.2-5.5, p =" 0.013)." srai predicted d3 severe aki with an auroc of 0.86 (95%ci 0.82-0.90), with greater specificity (74%) than d1 scr > Baseline (36%) and RAI + (58%). On multivariable regression, sRAI + retained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0-10.2, p < 0.001) and need for krt (aor 5.6, 95%ci 1.5-21.5, p =" 0.01)." conclusions: prediction of severe aki in pediatric septic shock is important to improve outcomes, allocate resources, and inform enrollment in clinical trials examining potential disease-modifying therapies. the srai affords more accurate and specific prediction than context-free scr elevation or the original rai in this population.>
