Data_Sheet_1_Re-evaluating Renal Angina Index: An Authentic, Evidence-Based Instrument for Acute Kidney Injury Assessment: Critical Appraisal.docx

Background/Introduction: Renal angina index (RAI) used to calculate and accurately predict risk for the development of acute kidney injury (AKI) has been heavily explored. AKI is traditionally diagnosed by an increase in serum creatinine (SCr) concentration or oliguria, both of which are neither specific nor sensitive, especially among children. An RAI score may be calculated by combining objective signs of kidney dysfunction (such as SCr) and patient context, such as AKI risk factors, thus potentially serving as a more accurate indicator for AKI.
Objective: Due to the propitious and novel nature of RAI, this editorial commentary aims to analyze the current literature on RAI and determine how well RAI serves as a predictor of AKI outcomes.
Method: A comprehensive literature search was conducted in PubMed/Medline and Google Scholar between January 2012 and July 2020. Literature included the prognostic aspect of early prediction of AKI in the pediatric and adult population via RAI.
Results: The initial literature search included 149 studies, and a total of 10 studies reporting the outcomes of interest were included. The overall sample size across these studies was 11,026. The predictive ability of RAI had a pooled (95% CI) sensitivity of 79.21%, specificity of 73.22%, and negative predictive value of 94.83%.
Conclusion: RAI shows benefit in the prediction of AKI among adult and pediatric populations. However, there is a lack of sufficient data, and further prospective studies are needed in pediatric populations to use RAI as a principal AKI indicator among clinicians.

背景/引言：用于计算并精准预测急性肾损伤（acute kidney injury, AKI）发病风险的肾绞痛指数（Renal angina index, RAI）已得到广泛研究探索。传统急性肾损伤诊断依据为血清肌酐（serum creatinine, SCr）浓度升高或少尿，但二者均缺乏特异性与敏感性，在儿童群体中尤为显著。RAI评分可通过结合肾功能不全的客观体征（如血清肌酐）与患者临床背景（如AKI危险因素）进行计算，有望成为更精准的AKI预测指标。
目的：鉴于RAI的应用前景与创新性，本社论评论旨在分析当前有关RAI的研究文献，并评估其作为AKI转归预测因子的效能。
方法：本研究于2012年1月至2020年7月间，在PubMed/Medline与Google Scholar数据库中开展了全面文献检索。纳入文献需涉及通过RAI对儿童与成人群体的AKI进行早期预测的预后相关研究。
结果：初步文献检索共获取149项研究，最终纳入10项报告了目标结局的研究，纳入研究的总样本量为11026例。经合并分析，RAI的预测能力在95%置信区间（95% CI）下的敏感性为79.21%，特异性为73.22%，阴性预测值为94.83%。
结论：RAI在成人与儿童群体的AKI预测中展现出应用价值。但目前相关数据仍不够充分，未来需开展更多前瞻性研究，以支持临床医师将RAI作为儿童群体AKI的主要评估指标。