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Assessment of a modified renal angina index for AKI prediction in critically ill adults.

BACKGROUND
The renal angina index (RAI) is a useful tool for risk-stratification of acute kidney injury (AKI) in critically ill children. We evaluated the performance of a modified adult RAI (mRAI) for the risk-stratification of AKI in critically ill adults.


METHODS
We used two independent ICU cohorts: 13,965 adult patients from the University of Kentucky (UKY) and 4,789 from UT Southwestern (UTSW). The mRAI included: diabetes, presence of sepsis, mechanical ventilation, pressor/inotrope use, percentage change in SCr in reference to admission SCr (ΔSCr), and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI stage ≥2 at Day 2-7. Performance and reclassification metrics were determined for the mRAI score compared to ΔSCr alone.


RESULTS
The mRAI score outperformed ΔSCr and readjusted probabilities to predict AKI stage ≥2 at Day 2-7: C-statistic: UKY 0.781 vs. 0.708 (IDI 2.2%) and UTSW 0.766 vs. 0.696 (IDI 1.8%), p<0.001 for both. In the UKY cohort, only 3.3% of patients with mRAI score <10 had the AKI event, while 16.4% of patients with mRAI score of ≥ 10 had the AKI event (NPV 96.8%). Similar findings were observed in the UTSW cohort as part of external validation.


CONCLUSIONS
In critically ill adults, the adult mRAI score determined within the first day of ICU admission outperformed changes in SCr for the prediction of AKI stage ≥2 at Day 2-7 of ICU stay. The modified adult RAI is a feasible tool for AKI risk-stratification in adult patients in the ICU.