Renal Angina Index, Disease Severity Scores, and Laboratory Parameters in Predicting Acute Kidney Injury in...

Acute kidney injury (AKI) is a major cause of morbidity and mortality in paediatric intensive care units (PICUs). Early identification of patients at risk remains challenging. This study aimed to evaluate the diagnostic performance of the Renal Angina Index (RAI), disease severity scores, and laboratory parameters in predicting AKI in critically ill children.

This prospective single-centre study included paediatric patients admitted to the PICU. RAI, Paediatric Logistic Organ Dysfunction-2 (PELOD-2), Paediatric Risk of Mortality-3 (PRISM-3), and Paediatric Index of Mortality-3 (PIM-3) scores were calculated using standardised criteria. Vital signs and laboratory parameters were recorded at admission. Patients were divided into two groups based on whether or not they developed AKI by the 72nd hour of admission. The predictive performance of laboratory values and RAI, PELOD-2, PIM-3, and PRISM-3 scores for AKI was evaluated using ROC curves.

A total of 91 patients were included in the study. The male-to-female ratio was 2.13. The median age was 4.4 years (IQR: 8.6). The most common indication for admission to the PICU was trauma (n = 29%, 31.9%), followed by pneumonia/bronchiolitis (n = 20%, 22%), acute gastroenteritis/dehydration (n = 13%, 14.3%), and status epilepticus (n = 12%, 13.2%). RAI ≥ 8 was associated with a significantly increased likelihood of AKI (OR = 2.95; CI: 1.17-8.94, p = 0.040). Amongst severity scores, PELOD-2 (AUC = 0.719), and PRISM-3 (AUC = 0.720) demonstrated moderate discriminatory ability. Laboratory markers showed variable predictive performance, with serum albumin (AUC = 0.674), and glucose (AUC = 0.664) emerging as the strongest predictors of AKI.

Low albumin and high glucose values at PICU admission were found to be significantly associated with AKI development and may contribute to early risk stratification of AKI. Also, RAI and disease severity scores were shown to contribute significantly to predicting the risk of kidney injury. These findings highlight the potential utility of incorporating routine biochemical markers into early AKI risk stratification models in paediatric intensive care settings.