McGillicuddy Edward A, Schuster Kevin M, Kaplan Lewis J, Maung Adrian A, Lui Felix Y, Maerz Linda L, Johnson Dirk C, Davis Kimberly A
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
J Trauma. 2010 Feb;68(2):294-7. doi: 10.1097/TA.0b013e3181cf7e40.
Computed tomography (CT) is the gold standard for the identification of occult injuries, but the intravenous (IV) contrast used in CT scans is potentially nephrotoxic. Because elderly patients have decreased renal function secondary to aging and chronic disease, we sought to determine the rate of acute kidney injury (AKI) in elderly trauma patients exposed to IV contrast.
Medical records of patients older than 55 years evaluated at a level-one trauma center between January 2003 and July 2008 were reviewed. Contrast was nonionic, isosmolar, and administered in standard volumes. Groups were based on administration of contrast. AKI was defined as a 25% relative or 0.5 mg/dL absolute increase in serum creatinine within 72 hours of presentation [corrected].
During the study period 1,371 patients older than 55 years were evaluated, and 1,152 met the inclusion criteria. CT was performed on 1,071 patients (96%); 71% of this group received IV contrast. There was no significant difference between the contrast and noncontrast groups in terms of baseline characteristics. Criteria for AKI were satisfied in 2.1% of all patients, including 1.9% the contrast group versus 2.4% in the noncontrast group. AKI diagnosed within 72 hours of patient presentation was an independent risk factor for in-hospital mortality and prolonged length of stay.
IV contrast media in elderly trauma patients is not associated with an increased risk of AKI. Development of AKI within 72 hours of admission is associated with mortality and increased length of stay.
计算机断层扫描（CT）是识别隐匿性损伤的金标准，但CT扫描中使用的静脉内（IV）造影剂具有潜在肾毒性。由于老年患者因衰老和慢性疾病导致肾功能下降，我们试图确定接受IV造影剂的老年创伤患者急性肾损伤（AKI）的发生率。
回顾了2003年1月至2008年7月在一级创伤中心接受评估的55岁以上患者的病历。造影剂为非离子型、等渗型，并以标准剂量给药。分组基于造影剂的使用情况。AKI定义为就诊后72小时内血清肌酐相对升高25%或绝对升高0.5mg/dL[校正后]。
在研究期间，对1371例55岁以上患者进行了评估，其中1152例符合纳入标准。1071例患者（96%）进行了CT检查；该组71%接受了IV造影剂。造影剂组和非造影剂组在基线特征方面无显著差异。所有患者中2.1%符合AKI标准，包括造影剂组的1.9%和非造影剂组的2.4%。患者就诊后72小时内诊断出的AKI是住院死亡率和住院时间延长的独立危险因素。
老年创伤患者使用IV造影剂与AKI风险增加无关。入院后72小时内发生AKI与死亡率和住院时间延长相关。
