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Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm.

Publication ,  Journal Article
Andrew, BY; Andrew, EY; Cherry, AD; Hauck, JN; Nicoara, A; Pieper, CF; Stafford-Smith, M
Published in: J Cardiothorac Vasc Anesth
October 2018

OBJECTIVE: Intraoperative Doppler-determined renal resistive index (RRI) is a promising early acute kidney injury (AKI) biomarker. As RRI continues to be studied, its clinical usefulness and robustness in research settings will be linked to the ease, efficiency, and precision with which it can be interpreted. Therefore, the authors assessed the usefulness of computer vision technology as an approach to developing an automated RRI-estimating algorithm with equivalent reliability and reproducibility to human experts. DESIGN: Retrospective. SETTING: Single-center, university hospital. PARTICIPANTS: Adult cardiac surgery patients from 7/1/2013 to 7/10/2014 with intraoperative transesophageal echocardiography-determined renal blood flow measurements. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Renal Doppler waveforms were obtained retrospectively and assessed by blinded human expert raters. Images (430) were divided evenly into development and validation cohorts. An algorithm for automated RRI analysis was built using computer vision techniques and tuned for alignment with experts using bootstrap resampling in the development cohort. This algorithm then was applied to the validation cohort for an unbiased assessment of agreement with human experts. Waveform analysis time per image averaged 0.144 seconds. Agreement was excellent by intraclass correlation coefficient (0.939; 95% confidence interval [CI] 0.921 to 0.953) and in Bland-Altman analysis (mean difference [human-algorithm] -0.0015; 95% CI -0.0054 to 0.0024), without evidence of systematic bias. CONCLUSION: The authors confirmed the value of computer vision technology to develop an algorithm for RRI estimation from automatically processed intraoperative renal Doppler waveforms. This simple-to-use and efficient tool further adds to the clinical and research value of RRI, already the "earliest" among several early AKI biomarkers being assessed.

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

October 2018

Volume

32

Issue

5

Start / End Page

2203 / 2209

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Reproducibility of Results
  • Renal Circulation
  • Predictive Value of Tests
  • Postoperative Complications
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Kidney
 

Citation

APA
Chicago
ICMJE
MLA
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Andrew, B. Y., Andrew, E. Y., Cherry, A. D., Hauck, J. N., Nicoara, A., Pieper, C. F., & Stafford-Smith, M. (2018). Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm. J Cardiothorac Vasc Anesth, 32(5), 2203–2209. https://doi.org/10.1053/j.jvca.2018.04.014
Andrew, Benjamin Y., Elias Y. Andrew, Anne D. Cherry, Jennifer N. Hauck, Alina Nicoara, Carl F. Pieper, and Mark Stafford-Smith. “Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm.J Cardiothorac Vasc Anesth 32, no. 5 (October 2018): 2203–9. https://doi.org/10.1053/j.jvca.2018.04.014.
Andrew BY, Andrew EY, Cherry AD, Hauck JN, Nicoara A, Pieper CF, et al. Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm. J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2203–9.
Andrew, Benjamin Y., et al. “Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm.J Cardiothorac Vasc Anesth, vol. 32, no. 5, Oct. 2018, pp. 2203–09. Pubmed, doi:10.1053/j.jvca.2018.04.014.
Andrew BY, Andrew EY, Cherry AD, Hauck JN, Nicoara A, Pieper CF, Stafford-Smith M. Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm. J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2203–2209.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

October 2018

Volume

32

Issue

5

Start / End Page

2203 / 2209

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Reproducibility of Results
  • Renal Circulation
  • Predictive Value of Tests
  • Postoperative Complications
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Kidney