Division of Nephrology, Department of Medicine, National University Hospital, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Eur Radiol. 2021 May;31(5):3258-3266. doi: 10.1007/s00330-020-07428-x. Epub 2020 Nov 7.
To determine if contrast-enhanced CT imaging performed in patients during their episode of AKI contributes to major adverse kidney events (MAKE).
A propensity score-matched analysis of 1127 patients with AKI defined by KDIGO criteria was done. Their mean age was 63 ± 16 years with 56% males. A total of 419 cases exposed to CT contrast peri-AKI were matched with 798 non-exposed controls for 14 covariates including comorbidities, acute illnesses, and initial AKI severity; outcomes including MAKE and renal recovery in hospital were compared using bivariate analysis and logistic regression. MAKE was a composite of mortality, renal replacement therapy, and doubling of serum creatinine on discharge over baseline; renal recovery was classified as early versus late based on a 7-day timeline from AKI onset to nadir creatinine or cessation of renal replacement therapy in survivors.
Sixty-two patients received cumulatively > 100 mL of CT contrast, 143 patients had > 50-100 mL, and 214 patients had 50 mL or less; MAKE occurred in 34%, 17%, and 21%, respectively, as compared with 20% in non-exposed controls (p = 0.008 for patients with > 100 mL contrast versus none). More contrast-exposed patients experienced late renal recovery (27% versus 20%) and longer hospital days (median 10 versus 8) than non-exposed patients (all p < 0.01). On multivariate analysis, cumulative CT contrast > 100 mL was independently associated with MAKE (odds ratio 2.39 versus non-contrast, adjusted for all confounders, p = 0.005); cumulative CT contrast under 100 mL was not associated with MAKE.
High cumulative volume of CT contrast administered to patients with AKI is associated with worse short-term renal outcomes and delayed renal recovery.
• Cumulative intravenous iodinated contrast for CT imaging of more than 100 mL, during an episode of acute kidney injury, was independently associated with worse renal outcomes and less renal recovery. • These adverse outcomes including renal replacement therapy were not more frequent in similar patients who received cumulatively 100 mL or less of CT contrast, compared with non-exposed patients. • More patients with CT contrast exposure during acute kidney injury experienced delayed renal recovery.
确定在急性肾损伤（AKI）发作期间接受对比增强 CT 成像的患者是否会导致主要不良肾脏事件（MAKE）。
对 1127 名符合 KDIGO 标准的 AKI 患者进行倾向评分匹配分析。他们的平均年龄为 63±16 岁，男性占 56%。共有 419 例 AKI 期间接受 CT 造影剂的病例与 798 例未暴露的对照进行了 14 项协变量的匹配，包括合并症、急性疾病和初始 AKI 严重程度；使用双变量分析和逻辑回归比较包括死亡率、肾脏替代治疗和出院时血清肌酐倍增在内的主要不良肾脏事件（MAKE）以及院内肾脏恢复情况。肾脏恢复根据从 AKI 发病到存活者血清肌酐最低点或停止肾脏替代治疗的 7 天时间线分为早期和晚期。
62 例患者累积接受 CT 造影剂>100ml，143 例患者接受 CT 造影剂>50-100ml，214 例患者接受 CT 造影剂 50ml 或更少；与未暴露对照（>100ml 造影剂患者为 20%）相比，分别有 34%、17%和 21%的患者出现 MAKE（接受>100ml 造影剂的患者与无造影剂者相比，p=0.008）。与未暴露患者相比，更多接受造影剂的患者出现晚期肾脏恢复（27%比 20%）和更长的住院天数（中位数 10 天比 8 天）（均 p<0.01）。多变量分析显示，累积 CT 造影剂>100ml 与 MAKE 独立相关（与无造影剂相比，优势比 2.39，调整所有混杂因素后，p=0.005）；累积 CT 造影剂<100ml 与 MAKE 无关。
急性肾损伤患者接受大量 CT 造影剂与短期肾脏结局恶化和肾脏恢复延迟有关。
