Sidharth Kumar Sethi1, Rupesh Raina2, Abhyuday Rana3, Gopal Agrawal4, Abhishek Tibrewal5, Naveen Bajaj6, Naveen Parkash Gupta7, Shishir Mirgunde8, Jagdish Sahoo9, Binesh Balachandran10, Kamran Afzal11, Anubha Shrivastava12, Jyoti Bagla13, Sushma Krishnegowda14, Ananth Konapur15, Kritika Soni1, Divya Sharma16, Amrit Khooblall17, Prajit Khooblall16, Timothy Bunchman18, Sanjay Wazir4. 1. Pediatric Nephrology, Kidney Institute, Medanta,The Medicity Hospital, Gurgaon, Haryana, 122001, India. 2. Pediatric Nephrology, Akron's Children Hospital, One Perkins Square, Akron, OH, 44308-1062, USA. rraina@akronchildrens.org. 3. Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, 122001, India. 4. Cloudnine Hospital, Gurgaon, Haryana, 122001, India. 5. Pediatric Nephrology, Akron's Children Hospital, One Perkins Square, Akron, OH, 44308-1062, USA. 6. Deep Hospital, Ludhiana, Punjab, India. 7. Madhukar Rainbow Children's Hospital, New Delhi, India. 8. Government Medical College, Miraj, Maharashtra, India. 9. Department of Neonatology, IMS & SUM Hospital, Bhubaneswar, India. 10. Aster Mims Hospital, Kottakkal, Kerala, India. 11. Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. 12. MLM Medical College, Prayagraj, Uttar Pradesh, India. 13. ESI Post Graduate Institute of Medical Science Research, Basaidarapur, New Delhi, India. 14. JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. 15. KIMS Hospital, Kurnool, Andhra Pradesh, India. 16. Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA. 17. Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA. 18. Children's Hospital of Richmond, Richmond, VA, USA.
Abstract
BACKGROUND: Neonatal acute kidney injury (AKI) is common in neonatal intensive care units (NICU) and leads to worse outcomes. Stratifying neonates into an "at risk" category allows health care providers to objectively recognize opportunities for improvements in quality of care. METHODS: The "Neonatal AKI Risk Prediction Scoring" was devised as the "STARZ [Sethi, Tibrewal, Agrawal, Raina, waZir]" Score. The STARZ score was derived from our prior multicentre study analysing risk factors for AKI in neonates admitted to the NICU. This tool includes 10 variables with a total score ranging from 0 to 100 and a cut-off score of 31.5. In the present study, the scoring model has been validated in our multicentre cohort of 744 neonates. RESULTS: In the validation cohort, this scoring model had sensitivity of 82.1%, specificity 91.7%, positive predictive value 81.2%, negative predictive value 92.2% and accuracy 88.8%. Based on the STARZ cut-off score of ≥ 31.5, an area under the receiver operating characteristic (ROC) curve was observed to be 0.932 (95% CI, 0.910-0.954; p < 0.001) signifying that the discriminative power was high. In the validation cohort, the probability of AKI was less than 20% for scores up to 32, 20-40% for scores between 33 and 36, 40-60% for scores between 37 and 43, 60-80% for scores between 44 and 49, and ≥ 80% for scores ≥ 50. CONCLUSIONS: To promote the survival of susceptible neonates, early detection and prompt interventional measures based on highly evidenced research is vital. The risk of AKI in admitted neonates can be quantitatively determined by the rapid STARZ scoring system. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Neonatal acute kidney injury (AKI) is common in neonatal intensive care units (NICU) and leads to worse outcomes. Stratifying neonates into an "at risk" category allows health care providers to objectively recognize opportunities for improvements in quality of care. METHODS: The "Neonatal AKI Risk Prediction Scoring" was devised as the "STARZ [Sethi, Tibrewal, Agrawal, Raina, waZir]" Score. The STARZ score was derived from our prior multicentre study analysing risk factors for AKI in neonates admitted to the NICU. This tool includes 10 variables with a total score ranging from 0 to 100 and a cut-off score of 31.5. In the present study, the scoring model has been validated in our multicentre cohort of 744 neonates. RESULTS: In the validation cohort, this scoring model had sensitivity of 82.1%, specificity 91.7%, positive predictive value 81.2%, negative predictive value 92.2% and accuracy 88.8%. Based on the STARZ cut-off score of ≥ 31.5, an area under the receiver operating characteristic (ROC) curve was observed to be 0.932 (95% CI, 0.910-0.954; p < 0.001) signifying that the discriminative power was high. In the validation cohort, the probability of AKI was less than 20% for scores up to 32, 20-40% for scores between 33 and 36, 40-60% for scores between 37 and 43, 60-80% for scores between 44 and 49, and ≥ 80% for scores ≥ 50. CONCLUSIONS: To promote the survival of susceptible neonates, early detection and prompt interventional measures based on highly evidenced research is vital. The risk of AKI in admitted neonates can be quantitatively determined by the rapid STARZ scoring system. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Shoo K Lee; Khalid Aziz; Michael Dunn; Maxine Clarke; Lajos Kovacs; Cecil Ojah; Xiang Y Ye Journal: Am J Perinatol Date: 2012-09-21 Impact factor: 1.862
Authors: Mignon I McCulloch; Victoria M Adabayeri; Selasie Goka; Tholang S Khumalo; Nilesh Lala; Shannon Leahy; Nokukhanya Ngubane-Mwandla; Peter J Nourse; Beatrice I Nyann; Karen L Petersen; Cecil S Levy Journal: Front Pediatr Date: 2022-08-31 Impact factor: 3.569