Observational studyJournal of the American Heart Association2025
Modification of the Cardiac Renal Angina Index for Predicting Adverse Kidney Events After Pediatric Cardiac Surgery.
Observational study in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The trial behind it
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Who cites it
4 citing papers in PubMed.
- Putting the pieces together: solving the puzzle of early acute kidney injury post pediatric cardiac surgery.Pediatric research · 2026Article
- Extracorporeal membrane oxygenation, acute kidney injury, fluid balance, and continuous renal replacement therapy: Acute Disease Quality Initiative (ADQI) and Extracorporeal Life Support Organization (ELSO) joint consensus conference.Intensive care medicine · 2026Article
- Research progress on biomarkers for acute kidney injury in children.Pediatric nephrology (Berlin, Germany) · 2026Review
- Fluid Creep as an Independent Predictor of Fluid Overload and Mortality in Critically Ill Patients: A Cohort Study.Life (Basel, Switzerland) · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundPediatric cardiac surgery-associated acute kidney injury is common and associated with poor outcomes, but early prediction is challenging. The purpose of this study was to determine the performance of a modified cardiac renal angina index (cRAI) in predicting adverse renal events and whether biomarker integration (urine neutrophil gelatinase-associated lipocalin) enhances cRAI performance.
methodsThis was a 2-center prospective observational study in children ages 0 to 18 years admitted to the intensive care unit after cardiac surgery. The cRAI was presented as a nomogram using multivariable logistic regression to predict a composite of (1) any postoperative day 2 to 4 acute kidney injury, or (2) mechanical ventilation ≥3 days. The performance of including urine neutrophil gelatinase-associated lipocalin into the nomogram was compared with the model constructed for cRAI alone.
resultsOf 476 patients, 129 (27%) experienced the composite outcome, and 191 (40%) were cRAI positive. Patients who were cRAI positive were younger, had higher surgical complexity, a higher mortality rate, and longer intensive care unit length of stay. cRAI predicted the composite outcome with an optimism-corrected area under the receiver operating characteristic curve of 0.82, sensitivity of 0.81 (95% CI, 0.73-0.87), specificity of 0.75 (95% CI, 0.70-0.80), and negative predictive value of 0.91 (95% CI, 0.87-0.94). Incorporating urine neutrophil gelatinase-associated lipocalin improved predictive performance, with an area under the receiver operating characteristic curve of 0.84, sensitivity of 0.84 (95% CI, 0.77-0.90), specificity of 0.79 (95% CI, 0.74-0.83), and negative predictive value of 0.93 (95% CI, 0.90-0.96).
conclusionsThe cRAI demonstrates strong predictive performance for adverse renal outcomes. Patients who were cRAI positive had worse outcomes, while the composite outcome was effectively ruled out in patients who were cRAI negative. Urine neutrophil gelatinase-associated lipocalin integration improved predictive performance parameters. cRAI holds potential for cardiac surgery-associated acute kidney injury risk stratification to enrich clinical trial enrollment.
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