Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Acad Emerg Med. 2013 Jan;20(1):40-5. doi: 10.1111/acem.12059.
Radiocontrast nephropathy (RCN) is a known complication of procedures in which intravascular iodinated contrast material is used. The authors sought to determine the risk factors for RCN after emergency department (ED) contrast-enhanced computerized tomography (CECT).
This was a retrospective case-control study of patients presenting to a tertiary care ED between January 1, 2004, and December 31, 2006. Inclusion criteria were CECT performed in the ED, serum creatinine measured prior to CECT, and serum creatinine measured 48 to 96 hours after CECT. Exclusion criterion was dialysis-dependent renal failure prior to CECT. The outcome of RCN was defined as an absolute creatinine increase of greater than or equal to 0.5 mg/dL, or a 25% increase above baseline. The charts of all RCN patients and a random sample of non-RCN patients were reviewed to document the presence or absence of potential risk factors. Univariate analysis was performed using chi-square and multiple logistic regression applying a weighted technique to account for sampling of non-RCN patients.
Among the 5,006 patients meeting inclusion criteria, 349 (7%) developed RCN. Multiple regression analysis demonstrated that serum creatinine > 2 mg/dL, liver disease, heart failure, hematocrit < 30%, hypertension, and diabetes were risk factors for RCN, whereas age > 75 years, vascular disease, and serum creatinine > 1.5 mg/dL were not. The area under the curve (AUC) for the model was 0.65. Although the risk of RCN increased with the number of risk factors present, we could not develop a model with sufficient diagnostic accuracy to guide clinical decision-making.
The authors report risk factors for RCN in a large case-control study, but could not develop an accurate decision tool to identify patients at increased risk for RCN after ED CECT.
放射对比肾病（RCN）是血管内碘造影剂使用的程序中已知的并发症。作者试图确定急诊部门（ED）增强计算机断层扫描（CECT）后 RCN 的危险因素。
这是一项回顾性病例对照研究，纳入了 2004 年 1 月 1 日至 2006 年 12 月 31 日期间在三级护理 ED 就诊的患者。纳入标准为 ED 中进行的 CECT、CECT 前测量的血清肌酐以及 CECT 后 48 至 96 小时测量的血清肌酐。排除标准为 CECT 前依赖透析的肾功能衰竭。RCN 的结果定义为绝对肌酐增加≥0.5mg/dL，或比基线增加 25%。回顾所有 RCN 患者和随机非 RCN 患者的图表，以记录潜在危险因素的存在或不存在。使用卡方检验进行单变量分析，应用加权技术对多变量逻辑回归进行分析，以考虑非 RCN 患者的抽样。
在符合纳入标准的 5006 名患者中，有 349 名（7%）发生了 RCN。多元回归分析表明，血清肌酐>2mg/dL、肝病、心力衰竭、红细胞压积<30%、高血压和糖尿病是 RCN 的危险因素，而年龄>75 岁、血管疾病和血清肌酐>1.5mg/dL 则不是。该模型的曲线下面积（AUC）为 0.65。尽管 RCN 的风险随着存在的危险因素数量的增加而增加，但我们无法开发出具有足够诊断准确性的模型来指导临床决策。
作者在一项大型病例对照研究中报告了 RCN 的危险因素，但无法开发出一种准确的决策工具来识别 ED CECT 后 RCN 风险增加的患者。
