Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Surg. 2016 Nov;35:69-75. doi: 10.1016/j.ijsu.2016.09.007. Epub 2016 Sep 10.
Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI.
We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality.
CIN was independently associated with body mass index (BMI) ≥ 30 kg/m (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality.
In this study, we found that BMI ≥ 30 kg/m, ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI.
虽然血管栓塞术可提高非手术治疗钝性脾损伤（BSI）患者的成功率，但由于连续使用造影剂，对比剂诱导的肾病（CIN）的问题仍不清楚。我们旨在研究 CIN 的危险因素及其对 BSI 患者死亡率的临床影响。
我们回顾性研究了 2003 年 7 月至 2015 年 6 月间 377 例 BSI 创伤患者的完整数据，这些患者在 48 小时以上存活。CIN 定义为造影后 48 小时内血清肌酐相对（≥25%）或绝对（≥0.5mg/dL）升高。采用多变量逻辑回归分析确定 CIN 和死亡率的独立预测因素。
CIN 与体重指数（BMI）≥30kg/m2（优势比[OR]：3.25，95%置信区间[CI]：1.20-8.76）、损伤严重程度评分（ISS）≥25（OR：6.08，95%CI：2.76-13.53）和 24 小时血红蛋白（Hb）<10g/dL（OR：3.16，95%CI：1.46-6.81）独立相关。CIN（OR：19.04，95%CI：6.15-58.94）和糖尿病（OR：3.43，95%CI：1.04-11.26）也被确定为死亡率的独立预测因素。
在这项研究中，我们发现 BMI≥30kg/m2、ISS≥25 和 24 小时 Hb<10g/dL 是 BSI 患者发生 CIN 的独立危险因素。然而，血管栓塞术并未被确定为 CIN 的独立危险因素。此外，CIN 和糖尿病被确定为 BSI 患者死亡率的独立危险因素。
