Mitchell A M, Kline J A
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28323-2861, USA.
J Thromb Haemost. 2007 Jan;5(1):50-4. doi: 10.1111/j.1538-7836.2006.02251.x. Epub 2006 Oct 5.
To estimate the frequency of contrast nephropathy after computed tomography angiography (CTA) to rule out pulmonary embolism (PE) in the emergency department (ED) setting.
We prospectively followed patients undergoing CTA for PE, while in the ED, for 45 days. Patients who refused follow-up or were receiving hemodialysis were excluded. Severe renal failure was defined as an increase in creatinine > or = 3.0 mg dL(-1) or a need for hemodialysis within the follow-up period. Patients were also followed for laboratory-defined contrast nephropathy, defined as an increase in creatinine of > 0.5 mg dL(-1) or > 25%, within seven days following CTA.
A total of 1224 patients were followed, and 354 [29%, 95% confidence interval (CI): 26-32%] patients had paired (preCTA and post-CTA) creatinine measurements. None developed renal failure (0/1224; 0%, CI: 0-0.3%). 44 patients developed laboratory-defined contrast nephropathy, corresponding to an overall frequency of 4% (44/1224; CI: 3-5%) and 12% (44/354; 95% CI: 9-16%) among those with paired creatinine measurements.
Following CTA for PE, the incidence of severe renal failure was very low, but the incidence of laboratory-defined contrast nephropathy (4% overall and 12% of those with paired measurements) was higher than expected.
评估在急诊科进行计算机断层血管造影（CTA）以排除肺栓塞（PE）后发生对比剂肾病的频率。
我们对在急诊科接受CTA检查以排除PE的患者进行了为期45天的前瞻性随访。拒绝随访或正在接受血液透析的患者被排除。严重肾衰竭定义为随访期间肌酐升高≥3.0mg/dL或需要进行血液透析。还对患者进行了实验室定义的对比剂肾病随访，定义为CTA后7天内肌酐升高>0.5mg/dL或>25%。
共随访了1224例患者，其中354例（29%，95%置信区间[CI]：26-32%）患者有配对的（CTA前和CTA后）肌酐测量值。无人发生肾衰竭（0/1224；0%，CI：0-0.3%）。44例患者发生了实验室定义的对比剂肾病，总体发生率为4%（44/1224；CI：3-5%），在有配对肌酐测量值的患者中为12%（44/354；95%CI：9-16%）。
在CTA检查排除PE后，严重肾衰竭的发生率非常低，但实验室定义的对比剂肾病的发生率（总体为4%，有配对测量值的患者中为12%）高于预期。
