{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:42:42Z","timestamp":1790775762677,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Pediatric cardiac surgery\u2013associated 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\u2013associated lipocalin) enhances cRAI performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This was a 2\u2010center prospective observational study in children ages 0 to 18\u2009years 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 \u22653\u2009days. The performance of including urine neutrophil gelatinase\u2013associated lipocalin into the nomogram was compared with the model constructed for cRAI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Of 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\u2010corrected area under the receiver operating characteristic curve of 0.82, sensitivity of 0.81 (95% CI, 0.73\u20130.87), specificity of 0.75 (95% CI, 0.70\u20130.80), and negative predictive value of 0.91 (95% CI, 0.87\u20130.94). Incorporating urine neutrophil gelatinase\u2013associated lipocalin improved predictive performance, with an area under the receiver operating characteristic curve of 0.84, sensitivity of 0.84 (95% CI, 0.77\u20130.90), specificity of 0.79 (95% CI, 0.74\u20130.83), and negative predictive value of 0.93 (95% CI, 0.90\u20130.96).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The 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\u2013associated lipocalin integration improved predictive performance parameters. cRAI holds potential for cardiac surgery\u2013associated acute kidney injury risk stratification to enrich clinical trial enrollment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.042941","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T11:27:15Z","timestamp":1754998035000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Modification of the Cardiac Renal Angina Index for Predicting Adverse Kidney Events After Pediatric Cardiac Surgery"],"prefix":"10.1161","volume":"14","author":[{"given":"Katherine F.","family":"Melink","sequence":"first","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]},{"name":"Boston Children\u2019s Hospital, Harvard Medical School","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4473-8376","authenticated-orcid":false,"given":"Natalja L.","family":"Stanski","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Gorrell","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Alten","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A.","family":"Pettit","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus","place":["Aurora, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3711-8785","authenticated-orcid":false,"given":"Stuart L.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8550-3827","authenticated-orcid":false,"given":"Huaiyu","family":"Zang","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9404-7368","authenticated-orcid":false,"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3184-341X","authenticated-orcid":false,"given":"Rajit K.","family":"Basu","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shina","family":"Menon","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"SooHoo","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus","place":["Aurora, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7427-670X","authenticated-orcid":false,"given":"Katja M.","family":"Gist","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus","place":["Aurora, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31821201d3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.06.021"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2007.01379.x"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2016.01.011"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.066"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.19209"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-9-135"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-023-06133-3"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.29442"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.349"},{"key":"e_1_3_2_12_2","article-title":"Discriminatory precision of renal angina index in predicting acute kidney injury in children; 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