Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48103, USA.
Radiology. 2013 Apr;267(1):94-105. doi: 10.1148/radiol.12121394. Epub 2013 Jan 29.
To determine whether intravenous low-osmolality iodinated contrast material is associated with post-computed tomography (CT) acute kidney injury (AKI).
Institutional review board approval was obtained and patient consent waived for this HIPAA-compliant retrospective study. CT examinations performed over a 10-year period in adult inpatients with sufficient serum creatinine (SCr) data were identified. A one-to-one propensity-matched matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (10,121 unenhanced and 10,121 intravenous contrast-enhanced CT examinations in 20,242 patients). Propensity matching was performed with respect to likelihood of patient receiving intravenous contrast material (36 tested covariates). The primary endpoint was post-CT AKI by using Acute Kidney Injury Network SCr criteria; the secondary endpoint was post-CT AKI by using traditional SCr criteria for contrast material-induced nephrotoxicity (CIN; SCr increase ≥0.5 mg/dL [44.20 μmol/L] or ≥25%). Multivariate subgroup threshold analysis was performed (SCr <1.5 [<132.60 μmol/L]; ≥1.5 to ≥2.0 mg/dL [≥132.60 to ≥176.80 μmol/L]) and adjusted for assigned propensity scores.
Intravenous low-osmolality iodinated contrast material had a significant effect on the development of post-CT AKI for patients with pre-CT SCr levels of 1.6 mg/dL (141.44 μmol/L) or greater (odds ratio, 1.45; 95% confidence interval [CI]: 1.11, 1.89;P = .007). This effect strengthened as pre-CT SCr increased. Patients with stable SCr less than 1.5 mg/dL (132.60 μmol/L) were not at risk for developing CIN (P = .25, power > 95%). Both endpoints demonstrated similar results (eg, SCr ≥1.6 mg/dL [141.44 μmol/L] by using traditional CIN criteria: odds ratio, 1.64; 95% CI: 1.18, 2.28; P = .003). Post-CT AKI was prevalent in both the unenhanced and contrast-enhanced CT subgroups, and it increased with increases in pre-CT SCr. Many risk factors contributed to development of post-CT AKI, regardless of iodinated contrast material.
Intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor, but not in patients with a stable SCr level less than 1.5 mg/dL. Many factors other than contrast material can affect post-CT AKI rates.
确定静脉内低渗透压碘造影剂是否与 CT 后急性肾损伤（AKI）相关。
本 HIPAA 合规性回顾性研究获得了机构审查委员会的批准，并豁免了患者的同意。确定了在 10 年期间对有足够血清肌酐（SCr）数据的成年住院患者进行的 CT 检查。使用多变量分析影响的 CT 后 AKI 作为主要结局指标（20242 名患者的 10121 次未增强和 10121 次静脉内对比增强 CT 检查）进行了 1:1 倾向匹配的匹配队列分析。根据患者接受静脉内造影剂的可能性进行倾向匹配（36 个测试协变量）。主要终点为使用急性肾损伤网络（AKIN）SCr 标准的 CT 后 AKI；次要终点为使用传统的造影剂诱导的肾毒性（CIN；SCr 增加≥0.5mg/dL [44.20μmol/L] 或≥25%）的 SCr 标准的 CT 后 AKI。进行了多变量亚组阈值分析（SCr <1.5 [132.60μmol/L]；≥1.5 至≥2.0mg/dL [≥132.60 至≥176.80μmol/L]），并根据分配的倾向评分进行了调整。
对于 CT 前 SCr 水平为 1.6mg/dL（141.44μmol/L）或更高的患者，静脉内低渗透压碘造影剂对 CT 后 AKI 的发生有显著影响（优势比，1.45；95%置信区间[CI]：1.11，1.89；P=0.007）。随着 CT 前 SCr 的增加，这种影响增强。SCr 小于 1.5mg/dL（132.60μmol/L）的稳定患者不会发生 CIN（P=0.25，功率>95%）。两个终点都显示出类似的结果（例如，使用传统的 CIN 标准的 CT 前 SCr≥1.6mg/dL [141.44μmol/L]：优势比，1.64；95%CI：1.18，2.28；P=0.003）。未增强和对比增强 CT 亚组均存在 CT 后 AKI，并且随着 CT 前 SCr 的增加而增加。许多风险因素导致 CT 后 AKI 的发生，而与碘造影剂无关。
静脉内低渗透压碘造影剂是一种肾毒性危险因素，但在 SCr 水平稳定于 1.5mg/dL 以下的患者中并非如此。许多因素除了造影剂外，还会影响 CT 后 AKI 的发生率。
