危重病人改良的肾性心绞痛指数和肾脏预后：一项前瞻性队列研究

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-08-19 DOI:10.1016/j.tacc.2025.101587

Mohamed Anas P. , Vishal Shanbhag , Attur Ravindra Prabhu , Shankar Prasad Nagaraju , Dharshan Rangaswamy , Srinivas Vinayak Shenoy , Mohan Varadarayanahalli Bhojaraja , Indu Ramachandra Rao

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引用次数: 0

摘要

现有的急性肾损伤（AKI）风险预测工具侧重于预测AKI的发生，但很少涉及有临床意义的结果，如透析需求、死亡率和肾脏恢复。我们试图研究改良肾性心绞痛指数（mRAI）预测主要肾脏不良事件30 （MAKE30）的性能。方法：本前瞻性单中心观察性研究于2023年3月至2024年7月在印度一家三级医院的内科icu进行。我们纳入住院≥48小时的连续成人ICU患者，排除了患有终末期肾病、既往肾移植或入院时需要透析的患者。根据Matsuura等人的描述，在ICU入院后24小时，根据病情评分和血清肌酐的变化计算mRAI。主要终点是MAKE30，住院死亡率、新肾替代治疗（RRT）开始、出院或第30天持续肾功能不全的综合指标。采用受试者工作曲线下面积（AUROC）评价mRAI预测MAKE30的效果，并与其他评分进行比较。结果750例符合条件的患者中，326例（43.4%）经历了MAKE30。mRAI预测MAKE30的AUROC为0.75 (95% CI: 0.70 - 0.78)，数值上高于SEA-MAKE评分（AUROC 0.70）、SOFA评分（AUROC 0.70）和APACHE II评分（AUROC 0.68）。结论mRAI对危重患者的MAKE30预测具有较好的判别能力。虽然这可能是指导临床决策的一个有前途的工具，但进一步的研究是有必要的。临床试验注册号：CTRI/2023/04/051884。

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The modified renal angina index and renal outcomes in critically ill patients: a prospective cohort study

Introduction

Existing risk prediction tools for acute kidney injury (AKI) have focused on the prediction of AKI occurrence, but few have addressed clinically meaningful outcomes such as the need for dialysis, mortality and kidney recovery. We sought to study the performance of the modified renal angina index (mRAI) for prediction of major adverse kidney events 30 (MAKE30).

Methodology

This prospective single-centre observational study was conducted in the medical ICUs of a tertiary care hospital in India from March 2023 to July 2024. We included consecutive adult ICU patients with hospital stays ≥48 h, excluding those with end-stage kidney disease, prior kidney transplantation, or needing dialysis at admission. The mRAI was calculated 24 h after ICU admission based on condition scores and changes in serum creatinine, as described by Matsuura et al. The primary outcome was MAKE30, a composite of in-hospital mortality, new renal replacement therapy (RRT) initiation, or persistent renal dysfunction by discharge or day 30. The area under the receiver operating curve (AUROC) was used to assess the performance of the mRAI for MAKE30 prediction and compared with other scores.

Results

Among 750 eligible patients, 326 (43.4 %) experienced MAKE30. The mRAI had an AUROC of 0.75 (95 % CI: 0.70–0.78) for MAKE30 prediction, which was numerically higher than that of the SEA-MAKE score (AUROC 0.70), SOFA score (AUROC 0.70) and APACHE II score (AUROC 0.68).

Conclusion

The mRAI demonstrated good discriminative ability for MAKE30 prediction in critically ill patients. While this may be a promising tool to guide clinical decision-making, further research is warranted.