School of Psychology and Healthcare Management at Akasaka, Department of Healthcare Management, International University of Health and Welfare, Minato, Tokyo, Japan; Department of Clinical Research and Quality Management, Center of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan; Department of Digestive Diseases, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan.
Eur J Radiol. 2020 Aug;129:109074. doi: 10.1016/j.ejrad.2020.109074. Epub 2020 May 19.
To determine if endoscopic retrograde cholangiopancreatography (ERCP) performed within 72 h after contrast enhanced computed tomography (CECT) increases contrast-induced nephrotoxicity (CIN) risk in patients with abdominal complaints.
This single-center retrospective cohort study included consecutive adult patients with abdominal complaints who underwent CECT between October 1, 2016, and June 30, 2019 at an emergency department (ED). CIN was diagnosed based on serum creatinine (SCr) level >0.5 mg/dL within 72 h after CECT or that increased >25 % compared to pre-CECT level. Logistic regression analysis was performed to determine independent risk factors for CIN, including age, sex, body mass index, comorbidities, medication, pre-CECT SCr level >1.5 mg/dL, and ERCP performed within 72 h after CECT. For persistent CIN, SCr level was obtained after 3 months at the earliest and compared to data obtained within 72 h after ERCP and CECT.
Of 1457 patients with CECT, 90 (6.2 %) underwent ERCP within 72 h after CECT and 93 (6.4 %) developed CIN. Multivariate analysis revealed that ERCP performed within 72 h after CECT (odds ratio, 3.31; 95 % confidence interval, 1.74, 6.29; p < 0.001) and pre-CECT SCr level >1.5 mg/dL (odds ratio, 9.86; 95 % confidence interval, 5.08, 19.2; p < 0.001) were independent risk factors for CIN. Of 93 patients with CIN, 10 (11 %) had persistent CIN. No specific factors were correlated with persistent CIN in the 3-month time frame.
ERCP performed within 72 h after CECT and pre-CECT SCr level >1.5 mg/dL are associated with CIN development.
确定腹部不适患者在接受对比增强计算机断层扫描（CECT）后 72 小时内行内镜逆行胰胆管造影术（ERCP）是否会增加造影剂诱导的肾毒性（CIN）风险。
本单中心回顾性队列研究纳入了 2016 年 10 月 1 日至 2019 年 6 月 30 日期间在急诊科接受 CECT 的连续成年腹部不适患者。根据 CECT 后 72 小时内血清肌酐（SCr）水平>0.5mg/dL 或与 CECT 前水平相比升高>25%，诊断 CIN。采用 logistic 回归分析确定 CIN 的独立危险因素，包括年龄、性别、体重指数、合并症、药物治疗、CECT 前 SCr 水平>1.5mg/dL 以及 ERCP 在 CECT 后 72 小时内进行。对于持续性 CIN，最早在 3 个月后获取 SCr 水平，并与 CECT 和 ERCP 后 72 小时内的数据进行比较。
在 1457 例接受 CECT 的患者中，90 例（6.2%）在 CECT 后 72 小时内行 ERCP，93 例（6.4%）发生 CIN。多变量分析显示，CECT 后 72 小时内行 ERCP（比值比，3.31；95%置信区间，1.74，6.29；p<0.001）和 CECT 前 SCr 水平>1.5mg/dL（比值比，9.86；95%置信区间，5.08，19.2；p<0.001）是 CIN 的独立危险因素。在 93 例 CIN 患者中，10 例（11%）发生持续性 CIN。在 3 个月的时间内，没有特定因素与持续性 CIN 相关。
CECT 后 72 小时内行 ERCP 和 CECT 前 SCr 水平>1.5mg/dL 与 CIN 的发生有关。
