Department of Emergency Medicine, Mount Sinai Medical Center, New York, NY, USA.
Department of Radiology, Mount Sinai Medical Center, New York, NY, USA.
Emerg Radiol. 2021 Oct;28(5):899-902. doi: 10.1007/s10140-021-01942-1. Epub 2021 May 12.
The objectives of this study are to determine the efficacy of a roster of clinical factors in identifying risk for renal insufficiency in emergency department (ED) patients requiring intravenous contrast-enhanced CT scan (IVCE-CT) and to help mitigate potential for developing contrast-induced nephropathy (CIN).
A review was conducted of consecutive ED patients who received IVCE-CT during a 4-month period in our urban ED. The values of ED serum creatinine (SCr) performed were tabulated. The medical records of all patients with an elevated SCr (> 1.4 mg/dL) were reviewed to determine and correlate the presence of clinical risk factors for underlying renal insufficiency.
During the 4-month study period, there were 2260 consecutive cases who received IVCE-CT; of these, 2250 (99.6%) had concomitant measurement of SCr. Elevated SCr occurred in 141 patients (6.2%); of these, 75 had a SCr > 2 mg/dL. In all, 139/141 (98.6%) with an elevated SCr had an underlying chronic or acute medical condition identified by medical record review which potentially compromised renal function, including chronic renal disease, diabetes mellitus, HIV infection, cancer, hypertension, congestive heart failure, sepsis/septic shock, chronic alcoholism, and sickle cell disease. Two patients with no identified risk factor each had (mildly) elevated SCr; both had a normal SCr measured post-CT scan. The total cost of performing serum basic metabolic panel to measure SCr in all patients during the 4-month study period was $94,500.
Elevated SCr is rarely present in ED patients without recognized risk factors who receive IVCE-CT scan. The vast majority with underlying renal insufficiency are readily identified by a review of the patient's medical history and/or clinical findings. Routine SCr measurement on all ED patients regardless of risk stratification prior to IVCE imaging is neither time nor cost-effective.
本研究旨在确定一系列临床因素在识别需要静脉对比增强 CT 扫描（IVCE-CT）的急诊科（ED）患者发生肾功能不全风险方面的功效，并帮助减轻发生对比剂肾病（CIN）的潜在风险。
对在我院 ED 接受 IVCE-CT 的连续 ED 患者进行了回顾性研究。记录了 ED 血清肌酐（SCr）的检测值。回顾所有 SCr 升高（>1.4mg/dL）患者的病历，以确定和关联潜在肾功能不全的临床危险因素。
在 4 个月的研究期间，共有 2260 例连续接受 IVCE-CT 的患者；其中 2250 例（99.6%）同时测量了 SCr。141 例患者的 SCr 升高（6.2%）；其中 75 例患者的 SCr>2mg/dL。在所有 SCr 升高的 141 例患者中（98.6%），通过病历回顾确定了潜在的肾脏功能受损的基础慢性或急性疾病，包括慢性肾脏病、糖尿病、HIV 感染、癌症、高血压、充血性心力衰竭、脓毒症/感染性休克、慢性酒精中毒和镰状细胞病。2 例无明确危险因素的患者的 SCr 分别轻度升高；这两位患者在 CT 扫描后 SCr 正常。在 4 个月的研究期间，对所有患者进行血清基本代谢谱检测 SCr 的总费用为 94500 美元。
在接受 IVCE-CT 扫描但无明确危险因素的 ED 患者中，SCr 升高很少见。通过回顾患者的病史和/或临床发现，很容易识别出大多数有潜在肾功能不全的患者。在进行 IVCE 成像之前，无论风险分层如何，对所有 ED 患者常规测量 SCr 既不省时也不省钱。
