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

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An Editorial Commentary to this article was published on 21 May 2024

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.

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Data availability

The data that support the findings of this study are available from the corresponding author (KN) upon reasonable request.

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Funding

The Indian Council of Medical Research (ICMR) granted partial financial assistance [INR 50000] for this study as part of an award for the DM thesis during December 2021.

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Authors and Affiliations

  1. Pediatric Critical Care Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Muthuvel Rajangam, Karthi Nallasamy & Suresh Kumar Angurana

  2. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Anmol Bhatia

  3. Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Vinod Kumar & Prabhjot Kaur

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  1. Muthuvel Rajangam
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Correspondence to Karthi Nallasamy.

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Rajangam, M., Nallasamy, K., Bhatia, A. et al. Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06392-8

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