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Intensive Care Med. 2018 Nov;44(11):1904-1913. doi: 10.1007/s00134-018-5386-3. Epub 2018 Oct 5.

Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study.

Author information

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.

KEYWORDS:

Acute kidney injury; Doppler; Renal replacement therapy; Resistive index; Sensitivity; Specificity

PMID:
30291377
DOI:
10.1007/s00134-018-5386-3

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