Abstract: FR-PO048
Validation of Renal Angina Indices in Critically Ill Patients and Assessment of Urinary Biomarker Incorporation for AKI Prediction
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Zuñiga Gonzalez, Erick Yasar, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
- Villegas, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
- Del Toro-Cisneros, Noemi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
- Ortega, Rosario Guadalupe Hernandez, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- Galindo, Pablo E., Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico City, Mexico
- Cruz Rivera, Cristino, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
- Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
Background
The renal angina index (RAI) helps to predict acute kidney injury (AKI) in critically ill patients. Moreover, whether incorporation of urinary biomarkers into RAI may enhance severe AKI prediction is not kown.
Methods
This was a prospective cohort of patients admitted in two intensive care units (ICU) at third-level hospitals in Mexico City. Demographic, laboratory data and urinary samples were collected at ICU admission. RAI score was calculated using three methods at Day0: Matsuura, Ortiz-Soriano and Del Toro-Cisneros methods. AKI was defined according to KDIGO guidelines. The study aimed to evaluate RAI's predictive ability for severe AKI (stage 2 or 3) at 24 and 72 hours post-admission.
Results
Of the 134 patients analyzed, nineteen presented a stage 2 or 3 AKI over 72 hr follow-up. After evaluating all indices, RAI Matsuura presented the best performance in receiver-operating characteristics (ROC) analysis (cutoff of 10p) at 24hr (AUC 0.74, 95% IC 0.57-0.90) and 72hr (AUC 0.70, 95% IC 0.56-0.84). Neither urinary neutrophil gelatinase-associated lipocalin (uNGAL) nor urinary heat shock protein-72 (uHsp72) incorporation into RAIs improved ROC curve and discrimination for RAIs. [Table 1]
Conclusion
Our study highlights RAIs as a practical and useful tool for assessment of AKI risk in ICU adult patients. Urinary biomarkers incorporation does not improve accuracy for prediction of severe AKI, promoting RAIs' seamless integration into routine clinical assessments
Performance of different renal angina indices with and w/o addition of uNGAL
| AUC | Sensitivity | Specificity | PPV | NPV | |
| RAI Matsuura [cut-off 10p] 24hr 72hr | 0.74 (0.57-0.90) 0.70 (0.56-0.84) | 66% 57% | 81% 82% | 26% 35% | 96% 92% |
| RAI +/ NGAL + * 24hr 72hr | 0.66 (0.47-0.84) 0.65 (0.49-0.80) | 60% 56% | 72% 73% | 17% 25% | 95% 91% |
| RAI del Toro [cut-off 10p] 24hr 72hr | 0.68 (0.53-0.83) 0.69 (0.56-0.81) | 75% 73% | 61% 63% | 16% 25% | 96% 94% |
| RAI +/ NGAL +* 24hr 72hr | 0.70 (0.54-0.86) 0.68 (0.54-0.82) | 60% 75% | 72% 68% | 16% 24% | 95% 94% |
| RAI Ortiz-Soriano [cut-off 10p] 24hr 72hr | 0.62 (0.47-0.77) 0.60 (0.55-0.81) | 79% 83% | 43% 41% | 18% 12% | 92% 96% |
| RAI +/ NGAL +* 24hr 72hr | 0.66 (0.50-0.80) 0.65 (0.52-0.78) | 90% 88% | 42% 44% | 13% 19% | 98% 96% |
Predictive performance of RAIs for severe AKI (stage 2/3) at 24 and 72 hr. uNGAL cutoff based on Youden's optimal index: NGAL >152 ng/ml. *Patients included in the analysis n=118.