Weisbord Steven D, Chen Huanyu, Stone Roslyn A, Kip Kevin E, Fine Michael J, Saul Melissa I, Palevsky Paul M
VA Pittsburgh Healthcare System, Mailstop 111F-U, 7E Room 120, Pittsburgh, PA 15240, USA.
J Am Soc Nephrol. 2006 Oct;17(10):2871-7. doi: 10.1681/ASN.2006030301. Epub 2006 Aug 23.
The absence of a universally accepted definition of radiocontrast nephropathy (RCN) has hampered efforts to characterize effectively the incidence and the clinical significance of this condition. The objective of this study was to identify a clinically relevant definition of RCN by assessment of the relationships between increases in serum creatinine (Scr) of varying magnitude after coronary angiography and clinical outcomes. An electronic medical database was used to identify all patients who underwent coronary angiography at the University of Pittsburgh Medical Center during a 12-yr period and abstract Scr levels before and after angiography, as well as demographic characteristics and comorbid conditions. Changes in Scr after angiography were categorized into mutually exclusive categories on the basis of absolute and relative changes from baseline levels, with a separate category denoting "unknown" change. Discrete proportional odds models were used to examine the association between increases in Scr and 30-d in-hospital mortality and length of stay. A total of 27,608 patients who underwent coronary angiography were evaluated. Small absolute (0.25 to 0.5 mg/dl) and relative (25 to 50%) increases in Scr were associated with risk-adjusted odds ratios for in-hospital mortality of 1.83 and 1.39, respectively. Larger increases in Scr generally were associated with greater risks for these clinical outcomes. Small increases in Scr after the administration of intravascular radiocontrast are associated with adverse patient outcomes. This observation will help guide the post-procedure care of patients who undergo coronary angiography and has important implications for future studies that investigate RCN.
缺乏对放射性造影剂肾病（RCN）的普遍接受的定义，阻碍了有效描述该病症的发病率和临床意义的努力。本研究的目的是通过评估冠状动脉造影后不同程度的血清肌酐（Scr）升高与临床结局之间的关系，确定RCN的临床相关定义。使用电子医学数据库识别在匹兹堡大学医学中心12年期间接受冠状动脉造影的所有患者，并提取造影前后的Scr水平以及人口统计学特征和合并症。根据与基线水平的绝对和相对变化，将造影后Scr的变化分为相互排斥的类别，另有一个类别表示“未知”变化。使用离散比例优势模型来检验Scr升高与30天住院死亡率和住院时间之间的关联。总共评估了27608例接受冠状动脉造影的患者。Scr的小幅度绝对升高（0.25至0.5mg/dl）和相对升高（25至50%）分别与住院死亡率的风险调整优势比1.83和1.39相关。Scr的较大升高通常与这些临床结局的更高风险相关。血管内注射放射性造影剂后Scr的小幅升高与不良患者结局相关。这一观察结果将有助于指导接受冠状动脉造影患者的术后护理，并对未来研究RCN具有重要意义。
