Validation of the STARZ neonatal acute kidney injury risk stratification score in an independent prospective cohort

Dhooria, G. S., Nautiyal, A., Wazir, S., Agrawal, G., Tiwana, A., Bajaj, N., Gupta, N. P., Mirgunde, S., Sahoo, J., Balachandran, B., Afzal, K., Shrivastava, A., Bagla, J., Krishnegowda, S., Konapur, A., Soni, K., McCulloch, M., Bunchman, T., Sethi, S. K. | JNPM 2023;

Abstract: OBJECTIVE: A rapid AKI risk assessment score would allow for improving management and outcomes. STARZ (Sethi, Tibrewal, Agrawal, Raina, waZir) score was developed for acute kidney injury (AKI) risk stratification of critically ill neonates. This is the first independent validation for the novel score outside the original enrolled centres. STUDY DESIGN: 750 neonates were included in the study. The STARZ score was calculated after 12 hours of admission. Neonates admitted in NICU and receiving IV fluids for at least 48 hours were included. RESULTS: A total of 8.8% neonates had AKI in the first 7 days post admission. The duration of hospital stay was significantly higher among neonates with AKI [10.5 (7–19) vs. 7 (5–10) days; p < 0.001]. Mortality risk was 6.4 times higher among those with AKI [8 (12.1%) vs. 13 (1.9%); p < 0.001; RR (95% CI): 6.38 (2.74–14.83)]. In this study, the STARZ neonatal scoring model showed a sensitivity of 89.4% in detecting AKI with a 90.9% specificity and a high negative predictive value of 98.9%. The area under ROC was 0.958 (0.934–0981) - a high discriminative power. CONCLUSIONS: The STARZ score allows for AKI risk stratification, providing opportunity for therapeutic interventions which may improve outcomes in critically ill neonates.

*Corresponding Author: 

Dr Rupesh Raina, Pediatric Nephrology, Akron Children’s Hospital, One Perkins Square, Akron, Ohio, 44308-1062, USA. Tel.: +1 330 543 8950, Cell: +1 216 401 7894; Fax: +1 330 543 3980; E-mail: