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Tabla 2: Grupos de criterios diagnósticos propuestos para SAKI y criterios de elevación de Cr sin cumplir definición de LRA, en los cuales fueron evaluados los índices S-AKI SS y R-AKI SS. |
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Grupos de criterios diagnósticos propuestos para SAKI |
Elevación de Cr |
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SAKI por elevación de Cr encima del LSN establecido por SOFA «estándar de oro» |
SAKI por elevación de Cr encima del LSN por sexo |
SAKI por elevación de Cr encima del LSN por SOFA o por disminución del índice urinario |
SAKI por disminución del índice urinario |
Elevación de Cr encima del LSN por SOFA sin cumplir criterios KDIGO |
Elevación de Cr encima del LSN por sexo sin cumplir criterios KDIGO |
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LSN de Cr y/o índice urinario |
Cr 1.1 md/dL (SOFA) |
Mujeres Cr 1.1 mg/dL y hombres Cr 1.3 mg/dL |
Cr 1.1 md/dL (SOFA) y/o índice urinario ≥ 0.5 mL/kg/h |
Índice urinario ≥ 0.5 mL/kg/h |
Cr 1.1 md/dL (SOFA) |
Mujeres Cr 1.1 mg/dL y hombres Cr 1.3 mg/dL |
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|
Criterios utilizados para el diagnóstico |
Elevación de Cr al menos 0.3 mg/dL o mayor (KDIGO) |
Elevación de Cr al menos 0.3 mg/dL o mayor (KDIGO) |
Elevación de Cr al menos 0.3 mg/dL o mayor; disminución del índice urinario ≤ 0.4 mL/kg/h (KDIGO) |
Disminución del índice urinario ≤ 0.4 mL/kg/h (KDIGO) |
Elevación de Cr hasta un nivel ≤ 1.39 mg/dL |
Elevación de Cr hasta un nivel ≤ 1.39 mg/dL en mujeres y 1.59 mg/dL en hombres |
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|
AUC (IC 95%) Sig. |
0.841 (0.72-0.96) |
0.81 (0.67-0.94) |
0.690 (0.51-0.86) |
0.596 (0.41-0.77) |
0.897 (0.79-0.99) |
0.852 (0.72-0.97) |
S |
|
p < 0.001 |
p < 0.001 |
p = 0.067 |
p = 0.305 |
p < 0.001 |
p < 0.001 |
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0.774 (0.62-0.92) |
0.761 (0.61-0.90) |
0.693 (0.51-0.87) |
0.592 (0.41-0.77) |
0.819 (0.68-0.95) |
0.723 (0.55-0.88) |
R |
|
|
p < 0.003 |
p < 0.005 |
p = 0.062 |
p = 0.325 |
p < 0.001 |
p < 0.018 |
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OR (IC 95%) |
12.5 (2.22-70.1) |
10.5 (1.90-58.5) |
2.6 (0.60-11.2) |
1.5 (0.39-6.03) |
18 (3.34-96.7) |
18.3 (3.13-107.2) |
S |
|
7.9 (1.7-36.6) |
6.6 (1.46-30.4) |
3.7 (0.87-16.2) |
1.9 (0.51-7.58) |
7.04 (1.60-30.9) |
3.8 (0.94-15.2) |
R |
|
|
Sensibilidad (IC 95%) |
0.91 (0.79-1.03) |
0.9 (0.78-1.03) |
0.76 (0.60-0.91) |
0.74 (0.56-0.92) |
0.89 (0.77-1.01) |
0.92 (0.81-1.03) |
S |
|
0.86 (0.72-1.01) |
0.86 (0.71-1.01) |
0.76 (0.60-0.91) |
0.74 (0.56-0.92) |
0.81 (0.67-0.96) |
0.79 (0.63-0.95) |
R |
|
|
Especificidad (IC 95%) |
0.56 (0.33-0.79) |
0.53 (0.30-0.75) |
0.45 (0.16-0.75) |
0.35 (0.13-0.58) |
0.69 (0.44-0.94) |
0.63 (0.39-0.86) |
S |
|
0.56 (0.33-0.79) |
0.53 (0.30-0.75) |
0.55 (0.25-0.84) |
0.41 (0.18-0.65) |
0.62 (0.35-0.88) |
0.5 (0.26-0.75) |
R |
|
|
VPP (IC 95%) |
0.71 (0.55-0.88) |
0.68 (0.51-0.85) |
0.79 (0.63-0.94) |
0.61 (0.43-0.79) |
0.86 (0.73-0.99) |
0.79 (0.63-0.94) |
S |
|
0.7 (0.53-0.88) |
0.67 (0.49-0.84) |
0.81 (0.67-0.96) |
0.63 (0.45-0.81) |
0.81 (0.67-0.96) |
0.7 (0.53-0.88) |
R |
|
|
VPN (IC 95%) |
0.83 (0.62-1.04) |
0.83 (0.62-1.04) |
0.42 (0.14-0.70) |
0.5 (0.22-0.78) |
0.75 (0.51-1.0) |
0.83 (0.62-1.04) |
S |
|
0.77 (0.54-1.0) |
0.77 (0.54-1.0) |
0.46 (0.19-0.73) |
0.54 (0.27-0.81) |
0.62 (0.35-0.88) |
0.62 (0.35-0.88) |
R |
|
|
LR+ (IC 95%) |
2.07 (1.2-3.49) |
1.91 (1.17-3.13) |
1.38 (0.78-2.48) |
1.14 (0.75-1.75) |
2.87 (1.26-6.6) |
2.49 (1.28-4.65) |
S |
|
1.95 (1.13-3.34) |
1.83 (1.09-3.0) |
1.69 (0.85-3.29) |
1.25 (0.79-2.0) |
2.13 (1.04-4.31) |
1.58 (0.93-2.69) |
R |
|
|
LR− (IC 95%) |
0.16 (0.04-0.65) |
0.19 (0.05-0.71) |
0.53 (0.25-1.14) |
0.74 (0.32-1.73) |
0.16 (0.05-0.48) |
0.13 (0.03-0.52) |
S |
|
0.25 (0.08-0.74) |
0.26 (0.09-0.82) |
0.44 (0.21-0.92) |
0.63 (0.28-1.44) |
0.31 (0.13-0.70) |
0.42 (0.18-0.99) |
R |
|
|
Prevalencia |
0.55 |
0.53 |
0.73 |
0.57 |
0.68 |
0.6 |
S |
|
0.55 |
0.53 |
0.73 |
0.57 |
0.68 |
0.6 |
R |
|
|
Prior Odds |
1.22 |
1.11 |
2.64 |
1.35 |
2.08 |
1.5 |
S |
|
1.22 |
1.11 |
2.64 |
1.35 |
2.08 |
1.5 |
R |
|
|
Prob. Pretest |
0.55 |
0.53 |
0.73 |
0.57 |
0.68 |
0.6 |
S |
|
0.55 |
0.53 |
0.73 |
0.57 |
0.68 |
0.6 |
R |
|
|
Post Odds (+) |
2.53 |
2.11 |
3.64 |
1.54 |
5.96 |
3.74 |
S |
|
2.38 |
2.02 |
4.46 |
1.69 |
4.42 |
2.37 |
R |
|
|
Prob. Postest (+) (IC 95%) |
0.72 (0.59-0.81) |
0.68 (0.57-0.78) |
0.78 (0.68-0.87) |
0.61 (0.5-0.7) |
0.86 (0.73-0.93) |
0.79 (0.66-0.88) |
S |
|
0.7 (0.58-0.81) |
0.67 (0.55-0.77) |
0.82 (0.7-0.9) |
0.63 (0.51-0.73) |
0.82 (0.69-0.90) |
0.7 (0.58-0.8) |
R |
|
|
Post Odds (−) |
0.2 |
0.2 |
1.4 |
1.0 |
0.3 |
0.2 |
S |
|
0.3 |
0.3 |
1.2 |
0.8 |
0.7 |
0.6 |
R |
|
|
Prob. Postest (−) (IC 95%) |
0.16 (0.05-0.44) |
0.18 (0.05-0.45) |
0.59 (0.36-0.78) |
0.50 (0.28-0.72) |
0.25 (0.1-0.51) |
0.16 (0.04-0.44) |
S |
|
0.23 (0.09-0.48) |
0.23 (0.08-0.48) |
0.54 (0.34-0.73) |
0.46 (0.26-0.67) |
0.40 (0.22-0.61) |
0.39 (0.2-0.61) |
R |
|
|
Índice de Youden |
0.47 |
0.43 |
0.21 |
0.09 |
0.58 |
0.55 |
S |
|
0.42 |
0.39 |
0.31 |
0.15 |
0.43 |
0.29 |
R |
|
|
Índice de exactitud |
0.75 |
0.72 |
0.67 |
0.57 |
0.82 |
0.80 |
S |
|
0.72 |
0.70 |
0.70 |
0.60 |
0.75 |
0.67 |
R |
|
|
Índice Torregroza |
0.66 |
0.62 |
0.51 |
0.26 |
0.78 |
0.75 |
S |
|
0.62 |
0.58 |
0.57 |
0.33 |
0.66 |
0.51 |
R |
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AUC = área bajo la curva. Cr = creatinina. IC 95% = intervalo de confianza al 95%. KDIGO = (Kidney Disease: Improving Global Outcomes). LRA = lesión renal aguda. LSN = límite superior. OR = razón de momios. R = R-AKI SS. S = S-AKI SS. SAKI = Sepsis Acute Kidney Injury. SOFA = Sequential [Sepsis-Related] Organ Failure Assessment. VPN = valor predictivo negativo. VPP = valor predictivo positivo. |
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