STARZ Neonatal AKI Risk Stratification Scoring
The STARZ [Sethi Tibrewal Agarwal Raina waZir] neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.
| Variables | Assigned Score | |
|---|---|---|
| Age at entry in NICU (hours) | ||
| PPV in the delivery room | ||
| Gestational age (weeks) | ||
| Sepsis (during the NICU stay) | ||
| Significant cardiac disease | ||
| Urine output^ (ml/kg/hr) | ||
| Serum creatinine^(mg/dl) | ||
| Use of nephrotoxic drugs | ||
| Use of furosemide | ||
| Use of Inotropes | ||
| Total | ||
^First 12 hours post admission in NICU
PPV: Positive pressure ventilation; NICU: Neonatal Intensive Care Unit; hr; hour; ml: millilitre; kg: kilogram; mg: milligram; dl: decilitre
Nephrotoxic drugs included Vancomycin or Colistin or Amphotericin B
We defined significant cardiac disease as hemodynamically significant patent ductus arteriosus [PDA]; persistent pulmonary hypertension of the newborn [PPHN]; cardiogenic shock and other congenital cardiac disease.
The probability of AKI is <20% with a score up to 37, 20–<40% for score 38–42, 40–<60% for score 43–48, 60–<80% for score 49–53, and ≥80% for score ≥54. This scoring model was observed to have 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% in the original study.
Reference: Wazir S, Sethi SK, Agarwal G, Tibrewal A, Dhir R, Bajaj N, Gupta NP, Mirgunde S, Sahoo J, Balachandran B, Afzal K, Shrivastava A, Bagla J, Krishnegowda S, Konapur A, Soni K, Rana A, Bunchman T, Raina R. Neonatal acute kidney injury risk stratification score: STARZ study. Pediatr Res. 2021 May 19. doi: 10.1038/s41390-021-01573-9. Epub ahead of print. PMID: 34012029.