Clinician Investigator Training Program, Department of Radiology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Radiology. 2013 Apr;267(1):106-18. doi: 10.1148/radiol.12121823. Epub 2013 Jan 29.
To determine the causal association and effect of intravenous iodinated contrast material exposure on the incidence of acute kidney injury (AKI), also known as contrast material-induced nephropathy (CIN).
This retrospective study was approved by an institutional review board and was HIPAA compliant. Informed consent was waived. All contrast material-enhanced (contrast group) and unenhanced (noncontrast group) abdominal, pelvic, and thoracic CT scans from 2000 to 2010 were identified at a single facility. Scan recipients were sorted into low- (<1.5 mg/dL), medium- (1.5-2.0 mg/dL), and high-risk (>2.0 mg/dL) subgroups of presumed risk for CIN by using baseline serum creatinine (SCr) level. The incidence of AKI (SCr ≥ 0.5 mg/dL above baseline) was compared between contrast and noncontrast groups after propensity score adjustment by stratification, 1:1 matching, inverse weighting, and weighting by the odds methods to reduce intergroup selection bias. Counterfactual analysis was used to evaluate the causal relation between contrast material exposure and AKI by evaluating patients who underwent contrast-enhanced and unenhanced CT scans during the study period with the McNemar test.
A total of 157,140 scans among 53,439 unique patients associated with 1,510,001 SCr values were identified. AKI risk was not significantly different between contrast and noncontrast groups in any risk subgroup after propensity score adjustment by using reported risk factors of CIN (low risk: odds ratio [OR], 0.93; 95% confidence interval [CI]: 0.76, 1.13; P = .47; medium risk: odds ratio, 0.97; 95% CI: 0.81, 1.16; P = .76; high risk: OR, 0.91; 95% CI: 0.66, 1.24; P = .58). Counterfactual analysis revealed no significant difference in AKI incidence between enhanced and unenhanced CT scans in the same patient (McNemar test: χ(2) = 0.63, P = .43) (OR = 0.92; 95% CI: 0.75, 1.13; P = .46).
Following adjustment for presumed risk factors, the incidence of CIN was not significantly different from contrast material-independent AKI. These two phenomena were clinically indistinguishable with established SCr-defined criteria, suggesting that intravenous iodinated contrast media may not be the causative agent in diminished renal function after contrast material administration.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121823/-/DC1.
确定静脉内碘造影剂暴露与急性肾损伤（AKI）发生率（又称造影剂诱导肾病（CIN））之间的因果关系和影响。
本回顾性研究经机构审查委员会批准，并符合 HIPAA 规定。免除了知情同意。在单一机构中，确定了 2000 年至 2010 年间所有增强（造影组）和未增强（非造影组）腹部、盆腔和胸部 CT 扫描。根据基线血清肌酐（SCr）水平，将扫描接受者分为低风险（<1.5mg/dL）、中风险（1.5-2.0mg/dL）和高风险（>2.0mg/dL）亚组，推测有 CIN 的风险。在进行倾向评分调整后，通过分层、1:1 匹配、反向加权和优势比方法加权，比较造影组和非造影组 AKI（SCr 比基线升高≥0.5mg/dL）的发生率，以减少组间选择偏倚。使用 McNemar 检验对研究期间接受增强和未增强 CT 扫描的患者进行反事实分析，以评估造影剂暴露与 AKI 之间的因果关系。
共确定了 53439 名患者的 157140 次扫描，共涉及 1510001 次 SCr 值。在使用 CIN 报告风险因素进行倾向评分调整后，造影组和非造影组在任何风险亚组中 AKI 风险均无显著差异（低风险：比值比[OR]，0.93；95%置信区间[CI]：0.76，1.13；P =.47；中风险：OR，0.97；95% CI：0.81，1.16；P =.76；高风险：OR，0.91；95% CI：0.66，1.24；P =.58）。反事实分析显示，同一患者增强和未增强 CT 扫描之间 AKI 的发生率无显著差异（McNemar 检验：χ(2) = 0.63，P =.43）（OR = 0.92；95% CI：0.75，1.13；P =.46）。
在调整了推测的风险因素后，CIN 的发生率与造影剂无关的 AKI 无显著差异。这两种现象在临床上难以区分，用既定的 SCr 定义标准，表明静脉内碘造影剂可能不是造影剂给药后肾功能下降的致病因素。
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121823/-/DC1.
