Table 4.
Comparison of three different definitions of renal angina fulfillment in pediatric septic shock for prediction of day 3 severe SA-AKI
| Characteristic | RAI ≥ 8 | RAI ≥ 20 | pltRAI+ | P |
|---|---|---|---|---|
| N (%) | 207 (55) | 116 (31) | 160 (42) | — |
| Male | 109 (53) | 63 (54) | 87 (54) | 0.93 |
| Age, years | 4.9 [1.2 to 10.4] | 4 [1.3 to 9.8] | 4.2 [1.4 to 9.5] | 0.93 |
| History of transplantation | 34 (16) | 25 (22) | 34 (21) | 0.39 |
| Severity of illness | ||||
| PRISM-III | 12 [8 to 18] | 14 [10 to 19] | 13 [9 to 19] | 0.15 |
| PERSEVERE-II | 0.019 [0.007 to 0.189]a | 0.178 [0.019 to 0.189]a | 0.167 [0.007 to 0.189] | 0.017 |
| D1 vasoactive use | 203 (98) | 115 (99) | 158 (99) | 0.72 |
| D1 mechanical ventilation use | 186 (90) | 108 (93) | 145 (91) | 0.62 |
| D3 SA-AKI | ||||
| All stage | 87 (42) | 70 (60) | 80 (50) | 0.007 |
| Severe | 64 (31) | 54 (47) | 62 (39) | 0.018 |
| D3 severe SA-AKI prediction | ||||
| AUROC (dichotomous)b | 0.76 (0.73 to 0.80)c | 0.82 (0.77 to 0.87)c,d | 0.82 (0.78 to 0.86)c | — |
| Sensitivity, % | 98 (91 to 99) | 83 (71 to 91) | 95 (86 to 99) | — |
| Specificity, % | 54 (49 to 60) | 80 (75 to 84) | 69 (63 to 74) | — |
| PPV, % | 31 (25 to 38) | 47 (37 to 56) | 39 (31 to 47) | — |
| NPV, % | 99 (96 to 99) | 96 (92 to 98) | 99 (96 to 99) | — |
| Positive likelihood ratio | 2.2 (1. to 2.4) | 4.2 (3.3 to 5.4) | 3.1 (2.6 to 3.6) | — |
| Negative likelihood ratio | 0.03 (0.004 to 0.20) | 0.21 (0.12 to 0.36) | 0.07 (0.02 to 0.20) | — |
| Youden’s index | 0.52 | 0.63 | 0.64 | — |
| RRT use | 37 (18) | 33 (28) | 37 (23) | 0.084 |
| PICU LOS, days | 8 [5 to 19] | 9 [6 to 19] | 9 [6 to 19] | 0.82 |
| Mortality | 35 (17) | 30 (26) | 34 (21) | 0.154 |
AUROC, area under the receiver operating curve; D, day; IQR, interquartile range; LOS, length of stay; NPV, negative predictive value; PERSEVERE-II, updated Pediatric Sepsis Biomarker Risk Model mortality probability; PICU, pediatric intensive care unit; pltRAI+, meets renal angina criteria by platelet count-modified RAI, which is defined as 1) RAI ≥ 20, or 2) RAI 8 to <20 with platelet count <150 × 103/μl; PPV, positive predictive value; PRISM-III, Pediatric Risk of Mortality Score; RAI, renal angina index; RRT, renal replacement therapy; SA-AKI, sepsis-associated acute kidney injury.
Values are n (%) unless otherwise noted. All continuous variables reported as median [IQR].
These two groups were different from each other on pairwise comparison.
AUROC reported for RAI ≥8, RAI ≥20, and pltRAI+ as dichotomous variables.
Statistically different groups on pairwise comparison.
RAI ≥ 8 was significantly different than both RAI ≥ 20 and pltRAI+.