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Neonatal acute kidney injury risk stratification score: STARZ study

Pediatric Research volume 91, pages 1141–1148 (2022)Cite this article

A Correction to this article was published on 14 September 2021

This article has been updated

Abstract

Background

Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify “at-risk” neonates for early preventive measures.

Methods

The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a “Risk Prediction Scoring” was devised [the STARZ score].

Results

The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%.

Conclusions

The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.

Impact

  • The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.

  • These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment.

  • With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.

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Fig. 1: Study flow chart.
Fig. 2: Calibration plot of the best fit multivariate logistic regression model.
Fig. 3: Receiver operative curve for the best fit model.
Fig. 4: Receiver operative curve for the scoring system.
Fig. 5: Scoring system dashboard.

Change history

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Author information

Author notes

  1. These authors contributed equally: Sanjay Wazir, Sidharth Kumar Sethi

Authors and Affiliations

  1. Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India

    Sanjay Wazir & Gopal Agarwal

  2. Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India

    Sidharth Kumar Sethi, Rohan Dhir & Kritika Soni

  3. Akron’s Children Hospital, Akron, OH, USA

    Abhishek Tibrewal & Rupesh Raina

  4. Neonatology, Deep Hospital, Ludhiana, Punjab, India

    Naveen Bajaj

  5. Neonatology, Madhukar Rainbow Children’s Hospital, New Delhi, India

    Naveen Parkash Gupta

  6. Government Medical College, Miraj, Maharashtra, India

    Shishir Mirgunde

  7. Department of Neonatology, IMS & SUM Hospital, Bhubaneswar, India

    Jagdish Sahoo

  8. Aster Mims Hospital, Kottakkal, Kerala, India

    Binesh Balachandran

  9. Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Uttar Pradesh, India

    Kamran Afzal

  10. MLM Medical College, Prayagraj, Uttar Pradesh, India

    Anubha Shrivastava

  11. ESI Post Graduate Institute of Medical Science Research, Basaidarapur, New Delhi, India

    Jyoti Bagla

  12. JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

    Sushma Krishnegowda

  13. KIMS Hospital, Kurnool, Andhra Pradesh, India

    Ananth Konapur

  14. Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India

    Abhyuday Rana

  15. Children’s Hospital of Richmond, Richmond, VA, USA

    Timothy Bunchman

Authors
  1. Sanjay Wazir
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Contributions

All authors made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data and drafting the article or revising it critically for important intellectual content. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Rupesh Raina.

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The authors declare no competing interests.

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Consent was taken from the parents for inclusion in the study.

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The original online version of this article was revised: Tables 1 and 3 have been revised. In the Discussion section, the information on urine output was changed and Figure 5 was corrected.

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Wazir, S., Sethi, S.K., Agarwal, G. et al. Neonatal acute kidney injury risk stratification score: STARZ study. Pediatr Res 91, 1141–1148 (2022). https://doi.org/10.1038/s41390-021-01573-9

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