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Pediatric Nephrology

13-05-2024 | Acute Kidney Injury | Original Article

Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children

Authors: Muthuvel Rajangam, Karthi Nallasamy, Anmol Bhatia, Vinod Kumar, Prabhjot Kaur, Suresh Kumar Angurana

Published in: Pediatric Nephrology

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Abstract

Background

Sepsis associated acute kidney injury (AKI) is linked with adverse outcomes in the PICU. Doppler-based renal resistive index (RRI) has shown promising results in adults for prediction of AKI. We aimed to explore the performance of RRI in children with sepsis.

Methods

This prospective observational study (March – November 2022) included children aged 1–12 years with sepsis admitted to the PICU. RRI and urine neutrophil gelatinase associated lipocalin (NGAL) were measured within 12 h of admission. Children were followed up for 3 days. AKI (new and persistent) was defined as any child with KDIGO stage 2 or 3 AKI on day 3.

Results

We enrolled 90 children but included 79 in final analysis. Two thirds (n = 53, 67%) had septic shock. Median (IQR) age was 6.2 years (4.1–9.2). RRI decreased with increasing age. Twenty-six (33%) children had AKI on day 3. Mean (SD) RRI was higher in the AKI group [0.72 (0.08) vs. 0.65 (0.07), p < 0.001].The area under ROC curve for RRI to detect AKI among the 1–4 year old group was 0.75 (95% CI:0.51, 0.98; p = 0.05) and among the 5–12 year old group was 0.76 (0.62, 0.89; p = 0.001). An RRI 0.71 predicted AKI with 100% sensitivity and 46.2% specificity among the 1–4-year-old group and RRI 0.69 predicted it with 70% sensitivity and 77.5% specificity in the 5–12-year-old group. RRI and eGFR at admission were independent predictors of AKI on multivariable analysis. Urine NGAL 94.8 ng/ml predicted AKI with 76.9% sensitivity and 77.4% specificity and AUROC was 0.74 (0.62, 0.86) among the 1–12-year-old group.

Conclusions

RRI values varied with age. RRI showed good diagnostic accuracy to detect new/persistent AKI on day 3 in children with sepsis; however, it was less precise as an independent predictor.

Graphical abstract

Appendix
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Metadata
Title
Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children
Authors
Muthuvel Rajangam
Karthi Nallasamy
Anmol Bhatia
Vinod Kumar
Prabhjot Kaur
Suresh Kumar Angurana
Publication date
13-05-2024
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-024-06392-8