Michael Darmon1,2,3, Aurelie Bourmaud4, Marie Reynaud5, Stéphane Rouleau6, Ferhat Meziani7,8, Alexandra Boivin7, Mourad Benyamina9, François Vincent10, Alexandre Lautrette11, Christophe Leroy11, Yves Cohen12, Matthieu Legrand13,9, Jérôme Morel5,14, Jeremy Terreaux15,16, David Schnell6,7. 1. Medical ICU, Saint-Louis University Hospital, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France. michael.darmon@aphp.fr. 2. Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. michael.darmon@aphp.fr. 3. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic, Sorbonne Paris Cité, CRESS), INSERM, Paris, France. michael.darmon@aphp.fr. 4. Hygée Centre and Public Health Department, Lucien Neuwirth Cancerology Institute, Saint-Priest-En-Jarez, France. 5. Surgical ICU, Saint-Etienne University Hospital, Saint-Etienne, France. 6. Medical-Surgical ICU, Angoulême Hospital, Angoulême, France. 7. Faculté de Médecine, Service de Réanimation, Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France. 8. INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France. 9. Surgical ICU and Burn Unit, Saint-Louis University Hospital, AP-HP, Paris, France. 10. Medical Surgical ICU, GHIC Le Raincy-Montfermeil, 93370, Montfermeil, France. 11. Intensive Care Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. 12. Medical-Surgical ICU, Avicenne University Hospital, AP-HP, Paris, France. 13. Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. 14. Saint-Etienne University, Jacques Lisfranc Medical School, Saint-Etienne, France. 15. Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Etienne, France. 16. Cardiology Unit, Saint-Etienne University Hospital, Saint-Etienne, France.
Abstract
PURPOSE: The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury (AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically ill patients. METHODS: Prospective multicenter cohort study including unselected critically ill patients. Renal Doppler was performed at admission to the intensive care unit. The diagnostic performance of RI and SQP to predict persistent AKI at day 3 was evaluated. RESULTS: Overall, 371 patients were included, of whom 351 could be assessed for short-term renal recovery. Two thirds of the included patients had AKI (n = 233; 66.3%), of whom 136 had persistent AKI (58.4%). Doppler-based RI was higher and SQP lower in AKI patients and according to AKI recovery. Overall performance in predicting persistent AKI was however poor with area under ROC curve of respectively 0.58 (95% CI 0.52-0.64) and 0.59 (95% CI 0.54-0.65) for RI and SQP. Optimal cutoff was respectively 0.71 and 2 for RI and SQP. At optimal cutoff, sensitivity and specificity were 50% (95% CI 41-58%) and 68% (62-74%) for RI and 39% (32-45%) and 75% (66-82%) for SQP. CONCLUSION: Although statistically associated with AKI occurrence, RI and SQP perform poorly in predicting persistent AKI at day 3. Further studies are needed to adequately describe factors influencing Doppler-based assessment of renal perfusion and to delineate whether these indicators may be useful at the bedside. CLINICALTRIAL.GOV: NCT02355314.
PURPOSE: The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury (AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically illpatients. METHODS: Prospective multicenter cohort study including unselected critically illpatients. Renal Doppler was performed at admission to the intensive care unit. The diagnostic performance of RI and SQP to predict persistent AKI at day 3 was evaluated. RESULTS: Overall, 371 patients were included, of whom 351 could be assessed for short-term renal recovery. Two thirds of the included patients had AKI (n = 233; 66.3%), of whom 136 had persistent AKI (58.4%). Doppler-based RI was higher and SQP lower in AKI patients and according to AKI recovery. Overall performance in predicting persistent AKI was however poor with area under ROC curve of respectively 0.58 (95% CI 0.52-0.64) and 0.59 (95% CI 0.54-0.65) for RI and SQP. Optimal cutoff was respectively 0.71 and 2 for RI and SQP. At optimal cutoff, sensitivity and specificity were 50% (95% CI 41-58%) and 68% (62-74%) for RI and 39% (32-45%) and 75% (66-82%) for SQP. CONCLUSION: Although statistically associated with AKI occurrence, RI and SQP perform poorly in predicting persistent AKI at day 3. Further studies are needed to adequately describe factors influencing Doppler-based assessment of renal perfusion and to delineate whether these indicators may be useful at the bedside. CLINICALTRIAL.GOV: NCT02355314.
Authors: D Schnell; M Reynaud; M Venot; A L Le Maho; M Dinic; M Baulieu; G Ducos; J Terreaux; F Zeni; E Azoulay; F Meziani; J Duranteau; M Darmon Journal: Minerva Anestesiol Date: 2014-02-25 Impact factor: 3.051
Authors: John R Prowle; Yan-Lun Liu; Elisa Licari; Sean M Bagshaw; Moritoki Egi; Michael Haase; Anja Haase-Fielitz; John A Kellum; Dinna Cruz; Claudio Ronco; Kenji Tsutsui; Shigehiko Uchino; Rinaldo Bellomo Journal: Crit Care Date: 2011-07-19 Impact factor: 9.097
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Renske Wiersema; Sakari Jukarainen; Ruben J Eck; Thomas Kaufmann; Jacqueline Koeze; Frederik Keus; Ville Pettilä; Iwan C C van der Horst; Suvi T Vaara Journal: Crit Care Date: 2020-04-21 Impact factor: 9.097
Authors: Peter Pickkers; Michael Darmon; Eric Hoste; Michael Joannidis; Matthieu Legrand; Marlies Ostermann; John R Prowle; Antoine Schneider; Miet Schetz Journal: Intensive Care Med Date: 2021-07-02 Impact factor: 17.440
Authors: Stefanie J Hectors; Sadjad Riyahi; Hreedi Dev; Karthik Krishnan; Daniel J A Margolis; Martin R Prince Journal: Abdom Radiol (NY) Date: 2020-10-24