Use of Doppler ultrasound renal resistive index and neutrophil gelatinase-associated lipocalin in prediction of acute kidney injury in patients with septic shock

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

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.

WITHDRAWN: Role of Cardiovascular Color Doppler Imaging Information Technology Under Artificial Intelligence Neural Network in the Diagnosis of Septic Shock Patients

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Renal resistive index as a marker of vascular damage in cardiovascular diseases

The article presents changeability of renal resistive index (RRI) in various cardiovascular diseases and considers the usefulness of the marker and interpretational difficulties of the index. The values of RRI are not specific to an individual disease, but in a selected group of patients, it seems to be a perfect marker of cardiovasculorenal changes and a predictor of rapid loss of a renal function. The RRI usually does not reflect the vascular resistance, but is dependent on total and local vascular bed compliance changing with age, in the course of consecutive diseases and the influence of drugs. Under specific conditions, RRI appears to be a good marker of vascular damage. This review summarizes current concepts in RRI interpretation against the cardiovascular pathologies, focusing on the vascular damage association with regard to the complex nature of RRI value variability.