Rashid A H, Brieva J L, Stokes B
Intensive Care Unit, John Hunter and Calvary Mater Hospital, Hunter New England Area Health, Newcastle, New South Wales, Australia.
Anaesth Intensive Care. 2009 Nov;37(6):968-75. doi: 10.1177/0310057X0903700613.
Computerised tomography (CT) with contrast is frequently used in intensive care. Contrast-induced nephropathy (CIN) is an important complication largely studied in stable cardiology patients and can lead to acute renal failure. The aim of this study was to determine the incidence of CIN in an intensive care unit (ICU) setting and describe the prevalence of associated risk factors. We performed a retrospective analysis by review of electronic laboratory database and manual chart review of all patients in two tertiary intensive care units in Newcastle, New South Wales who underwent CT with intravenous contrast during their ICU stay in 2006. CIN was defined as an absolute increment in serum creatinine of 44.2 micromol/l or a relative increment of 25% from baseline at 48 to 72 hours following intravenous contrast. Patients' demographic, biochemical and contrast media data, physiological parameters, fluid and drug administrations and previously described as well as ICU specific risk factors were analysed. We compared CIN positive and CIN negative patients to identify risk factors associated with CIN. In total, 2043 patients were admitted to ICU during 2006 and 509 CT studies were performed. One hundred and forty-one of these included administration of intravenous contrast and 139 charts were reviewed. Sixteen out of 139 patients developed CIN (11.5%). More than 70% of patients had two or more risk factors. Age was the only risk factor found to be significantly associated with the development of CIN in a multivariate analysis (P value 0.04, OR 1.041, 95% confidence interval 1.002 to 1.081). Mortality was higher in CIN positive patients (31 vs 13%, P value 0.068). ICU and hospital length of stay was not significantly different in CIN positive and negative patients and persisting renal impairment was not found in CIN positive survivors. Based on this study, we cannot predict who will develop CIN in ICU using the described risk factors. Further prospective studies are needed to evaluate the incidence and outcomes of CIN in an ICU setting.
计算机断层扫描（CT）增强检查在重症监护中经常使用。造影剂肾病（CIN）是一种重要并发症，主要在病情稳定的心脏病患者中进行研究，它可导致急性肾衰竭。本研究的目的是确定重症监护病房（ICU）环境下CIN的发生率，并描述相关危险因素的流行情况。我们通过回顾电子实验室数据库并人工查阅新南威尔士州纽卡斯尔市两家三级重症监护病房2006年入住ICU期间接受静脉造影CT检查的所有患者的病历进行了一项回顾性分析。CIN定义为静脉注射造影剂后48至72小时血清肌酐绝对升高44.2微摩尔/升或较基线相对升高25%。分析了患者的人口统计学、生化和造影剂数据、生理参数、液体和药物使用情况以及先前描述的以及ICU特有的危险因素。我们比较了CIN阳性和CIN阴性患者以确定与CIN相关的危险因素。2006年共有2043名患者入住ICU，进行了509次CT检查。其中141次检查包括静脉注射造影剂，共查阅了139份病历。139名患者中有16名发生了CIN（11.5%）。超过70%的患者有两个或更多危险因素。在多变量分析中，年龄是唯一被发现与CIN发生显著相关的危险因素（P值0.04，OR 1.041，95%置信区间1.002至1.081）。CIN阳性患者的死亡率更高（31%对13%，P值0.068）。CIN阳性和阴性患者的ICU和住院时间无显著差异，CIN阳性幸存者中未发现持续性肾功能损害。基于本研究，我们无法使用所描述的危险因素预测ICU中谁会发生CIN。需要进一步的前瞻性研究来评估ICU环境下CIN的发生率和结局。
