静脉注射碘造影剂后双侧持续显影：急性肾损伤、透析和死亡的潜在生物标志物。

Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material: A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality.

机构信息

Department of Radiology, Mayo Clinic, Rochester, MN.

出版信息

Mayo Clin Proc. 2018 Jul;93(7):867-876. doi: 10.1016/j.mayocp.2018.02.023.

DOI:10.1016/j.mayocp.2018.02.023

PMID:29976375

Abstract

OBJECTIVE

To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality.

PATIENTS AND METHODS

All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test.

RESULTS

A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4% (n=46), with a higher proportion following interventional (67% [18 of 30]) vs diagnostic (27.3% [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7% [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0% [17 of 46] vs 5.2% [4 of 77]; odds ratio [OR], 10.7 [95% CI, 3.31-34.5]; P<.001), dialysis (17.4% [8 of 46] vs 1.3% [1 of 77]; OR, 16.0 [95% CI, 1.93-133]; P=.001), and mortality (15.2% [7 of 46] vs 1.3% [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram.

CONCLUSION

The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.

摘要

目的

确定持续性双侧全肾显影是否与急性肾损伤（AKI）、透析和死亡相关。

方法

本研究纳入了 2000 年 1 月 1 日至 2014 年 12 月 31 日期间行（1）碘海醇增强 CT 或心脏导管检查，随后 24±6 小时内行非增强腹部 CT 的所有患者。排除术前和术后未行肌酐检测或接受额外造影剂的患者。通过放射科医生的回顾和 CT 衰减测量来确定肾显影。采用单因素和多因素分析来确定肾显影的危险因素。采用 Fisher 确切检验比较有无双侧全肾显影的患者的 AKI（定义为肌酐水平≥0.5mg/dL 或肾脏病：改善全球预后分期 1-3 期）、透析和死亡率比例。

结果

共有 123 名患者符合所有纳入标准。肾显影的患者比例为 37.4%（n=46），介入（67%[18/30]）和诊断性（27.3%[9/33]）导管检查或增强 CT 后肾显影比例更高，分别为 31.7%[19/60]。年龄（P=0.002）、慢性肾脏病（P=0.05）和急性低血压或休克（P=0.02）是肾显影发展的显著危险因素。有肾显影的患者 AKI 发生率显著更高（37.0%[17/46] vs 5.2%[4/77]；比值比[OR]，10.7[95%CI，3.31-34.5]；P<0.001）、透析（17.4%[8/46] vs 1.3%[1/77]；OR，16.0[95%CI，1.93-133]；P=0.001）和死亡率（15.2%[7/46] vs 1.3%[1/77]；OR，13.6[1.62-115]；P=0.003）也显著高于无肾显影的患者。