静脉注射 CT 对比剂与急性肾损伤：一项基于多中心急诊科的研究。
Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department-based Study.
机构信息
From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan.
出版信息
Radiology. 2021 Dec;301(3):571-581. doi: 10.1148/radiol.2021204446. Epub 2021 Oct 12.
Background Although the historical risk of acute kidney injury (AKI) after intravenous administration of contrast media might be overstated, the risk in patients with impaired kidney function remains a concern. Purpose To investigate whether intravenous contrast media administration during CT is associated with a higher risk of AKI and further hemodialysis compared with the risk in patients undergoing unenhanced CT. Materials and Methods This retrospective study evaluated patients who underwent contrast-enhanced or unenhanced CT in five Taiwanese emergency departments between 2009 and 2016. The outcomes were AKI within 48-72 hours after CT, AKI within 48 hours to 1 week after CT, or further hemodialysis within 1 month after CT. The associations between contrast media exposure and outcome were estimated by using an overlap propensity score weighted generalized regression model. Subgroup analyses were performed according to the estimated glomerular filtration rate (eGFR). Results The study included 68 687 patients (median age, 68 years; interquartile range, 53-74 years; 39 995 men) with ( = 31 103) or without ( = 37 584) exposure to contrast media. After propensity score weighting, contrast media exposure was associated with higher risk of AKI within 48-72 hours after CT (odds ratio [OR], 1.16; 95% CI: 1.04, 1.29; = .007) but no significant risk at 48 hours to 1 week after CT (OR, 1.00; 95% CI: 0.93, 1.08; = .90). Among patients with eGFR less than 30 mL/min/1.73 m, exposure to contrast media was associated with a higher AKI risk (48-72 hours after CT: OR, 1.36; 95% CI: 1.09, 1.70; = .007) (48 hours-1 week after CT: OR, 1.49; 95% CI: 1.27, 1.74; < .001) and a higher risk of hemodialysis (OR, 1.36; 95% CI: 1.09, 1.70; = .008). For patients with eGFR greater than 45 mL/min/1.73.m, contrast media exposure was not associated with higher AKI risk ( > .05). Conclusion Contrast-enhanced CT was associated with higher risk of acute kidney injury and further hemodialysis among Taiwanese patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m but not those with an eGFR of more than 45 mL/min/1.73 m. © RSNA, 2021
背景 静脉内给予造影剂后发生急性肾损伤 (AKI) 的历史风险可能被夸大，但肾功能受损患者的风险仍令人担忧。
目的 旨在探究与未增强 CT 相比，CT 期间静脉内给予造影剂是否与 AKI 风险增加和进一步血液透析相关。
材料与方法 本回顾性研究纳入 2009 年至 2016 年间在台湾 5 家急诊科行增强或未增强 CT 的患者。结局为 CT 后 48-72 小时内 AKI、CT 后 48 小时至 1 周内 AKI 或 CT 后 1 个月内进一步血液透析。采用重叠倾向评分加权广义回归模型估计造影剂暴露与结局之间的相关性。根据估计肾小球滤过率 (eGFR) 进行亚组分析。
结果 本研究纳入 68687 例患者（中位年龄，68 岁；四分位间距，53-74 岁；39995 例男性），其中 31103 例患者（暴露组）接受了造影剂检查，37584 例患者（未暴露组）未接受造影剂检查。在进行倾向评分加权后，与未暴露组相比，暴露组 CT 后 48-72 小时内 AKI 的风险更高（比值比，1.16；95%CI：1.04，1.29； =.007），但 CT 后 48 小时至 1 周内 AKI 风险无显著差异（比值比，1.00；95%CI：0.93，1.08； =.90）。对于 eGFR 小于 30 mL/min/1.73 m 的患者，造影剂暴露与 AKI 风险增加相关（48-72 小时：比值比，1.36；95%CI：1.09，1.70； =.007）（48 小时-1 周：比值比，1.49；95%CI：1.27，1.74； <.001），且血液透析风险增加（比值比，1.36；95%CI：1.09，1.70； =.008）。对于 eGFR 大于 45 mL/min/1.73 m 的患者，造影剂暴露与 AKI 风险增加无关（ ＞.05）。
结论 在 eGFR 小于 30 mL/min/1.73 m 的台湾患者中，与未增强 CT 相比，增强 CT 与 AKI 和进一步血液透析风险增加相关，但在 eGFR 大于 45 mL/min/1.73 m 的患者中，造影剂暴露与 AKI 风险增加无关。
©2021 RSNA
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