The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study.
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ABSTRACT: Purpose
To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI).Materials and methods
We performed a multicenter, prospective, observational study in patients with stage I or II AKI. The FST (1 mg/kg for loop diuretic naïve patients and 1.5 mg/kg in patients previously exposed to loop diuretics) was administered. Subsequent urinary flow rate (UFR) recorded and predictive ability of urinary output was measured by the area under the curve receiver operatic characteristics (AuROC). Primary outcome was progression to Stage III AKI. Secondary outcomes included in-hospital mortality and adverse events.Results
We studied 92 critically ill patients. 23 patients progressed to stage III AKI and had significantly lower UFR (p < 0.0001). The UFR during the first 2 h was most predictive of progression to stage III AKI (AuROC = 0.87), with an ideal cut-off of less than 200mls, with a sensitivity of 73.9% and specificity of 90.0%.Conclusion
In ICU patients without severe CKD with mild AKI, a UFR of less than 200mls in the first 2 h after an FST is predictive of progression to stage III AKI. Future studies should focus on incorporating a FST as part of a clinical decision tool for further management of critically ill patients with AKI.
SUBMITTER: Rewa OG
PROVIDER: S-EPMC8704439 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
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Project description:BackgroundAcute kidney injury (AKI) occurs in one in four children admitted to the intensive care unit (ICU) and AKI severity is independently associated with increased patient morbidity and mortality. Early prediction of AKI has the potential to improve outcomes. In smaller, single center populations, we have previously derived and validated the performance of the renal angina index (RAI), a context driven risk stratification system, to predict severe AKI.MethodsA prospective, observational study (AWARE1, January-December 2014) was conducted in intensive care units from 32 centers in 9 countries. The primary outcome was the presence of severe AKI ("AKIS"; Stage 2-3 AKI KDIGO guidelines) on the third day after ICU admission (). We compared the performance of the RAI to changes in serum creatinine relative to baseline (SCr/Base) for prediction of the primary outcome and secondary outcomes of interest. A RAI ≥ 8 defined fulfillment of renal angina (RA+); RA+ was compared to SCr increased relative to baseline ("SCr>Base"; using maximum SCr in first 12 hours of ICU admission).FindingsThe 1590 patients studied were 55% male and had median age of 54.5 months. 286 patients (17.9%) were RA+. AKIS occurred in 121 (42.3%) RA+ vs. 247 (18.9%) RA-patients (relative risk (RR) 2.23; 95% confidence interval (CI): 1.87-2.66, p<0.001). 368 (23.1%) patients with AKIS had increased renal replacement therapy utilization (10.9% vs. 1.5%, p<0.001) and increased mortality (7.6% vs. 4.3%, p=0.01) compared to patients without AKIS. RA+ demonstrated better prediction for AKIS than SCr>Base (RR: 1.61; (1.33-1.93), p<0.001) which was maintained on multivariate regression (independent odds ratio (OR): RA+ 3.21; 95% CI (2.20-4.67) vs. SCr>Base 0.68; 95% CI (0.49-4.94)).InterpretationEarlier, better prediction of severe AKI has the potential to improve AKI associated patient outcomes. Compared to isolated, context-free changes in SCr, renal angina risk assessment improved accuracy for prediction of severe AKI in critically ill children and young adults.
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