增强 CT 后患者对比剂相关急性肾损伤的新危险因素：一项回顾性研究。
A novel risk factor of contrast associated acute kidney injury in patients after enhanced computed tomography: a retrospective study.
机构信息
Nephrology, Zhujiang Hospital, Southern Medical University, GuangZhou, GuangDong, China.
Nephrology, Huizhou Central People's Hospital, Huizhou, Guangdong, China.
出版信息
PeerJ. 2022 Oct 20;10:e14224. doi: 10.7717/peerj.14224. eCollection 2022.
BACKGROUND
Contrast associated acute kidney injury (CA-AKI) is a major cause of acute renal failure and the incidence of CA-AKI is still high in recent years. Risk stratification is traditionally based on glomerular filtration rate(GFR). Hence, the aim of this study was to explore the novel risk factors for CA-AKI after enhanced computed tomography (CT).
METHODS
A retrospective cohort study was conducted in 632 in-hospital patients undergoing enhanced CT. The patients were divided into CA-AKI and no-CA-AKI groups. For comparative analyses, we applied one-to-four cohorts of those two groups using propensity score-matching methods addressing the imbalances of age, gender, weight, and smoking. The baseline clinical and biochemical data were compared. Logistic regression analysis was employed to investigate the CA-AKI risk factors. The receiver operating characteristic (ROC) curve was adopted to test the value of RDW in predicting CA-AKI after enhanced CT.
RESULTS
25 (3.96%) patients suffered from CA-AKI. Those subjects who developed CA-AKI had advanced age, severer renal functional injury, lower albumin, higher baseline RDW, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) than those without CA-AKI. It also exhibited more severe anemia including decreased hemoglobin and red blood cell count (all < 0.05). The baseline RDW, albumin and PLR between the two groups were statistically significant different after PSM. Binary logistic regression analysis showed that baseline RDW, albumin and eGFR were correlated with CA-AKI after contrast-enhanced CT examination. The RDW exhibited moderated discrimination ability for predicting CA-AKI beyond eGFR, with an AUC of 0.803 (95% CI [0.702-0.90]) vs 0.765 (95% CI [0.70-0.83]).
CONCLUSION
Increased baseline RDW and decreased eGFR are risk factors for CA-AKI after enhanced CT. RDW exhibited good predictive value and can be used as an early warning marker for patients suffering from CA-AKI after enhanced CT.
背景
对比剂相关急性肾损伤（CA-AKI）是急性肾衰竭的主要原因，近年来 CA-AKI 的发病率仍然很高。风险分层传统上基于肾小球滤过率（GFR）。因此，本研究旨在探讨增强 CT 后 CA-AKI 的新危险因素。
方法
对 632 例住院患者进行增强 CT 回顾性队列研究。患者分为 CA-AKI 组和非 CA-AKI 组。为了进行比较分析，我们应用倾向评分匹配方法，将两组患者按照年龄、性别、体重和吸烟情况进行一对一四对匹配。比较两组的基线临床和生化数据。采用 logistic 回归分析探讨 CA-AKI 的危险因素。采用受试者工作特征（ROC）曲线检验红细胞分布宽度（RDW）在预测增强 CT 后 CA-AKI 的价值。
结果
25 例（3.96%）患者发生 CA-AKI。发生 CA-AKI 的患者年龄较大，肾功能损伤较重，白蛋白水平较低，基线 RDW、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）较高，贫血较重，包括血红蛋白和红细胞计数降低（均<0.05）。PSM 后两组基线 RDW、白蛋白和 PLR 差异有统计学意义。二元 logistic 回归分析显示，增强 CT 检查后，基线 RDW、白蛋白和 eGFR 与 CA-AKI 相关。RDW 对预测 CA-AKI 的能力优于 eGFR，AUC 为 0.803（95%CI[0.702-0.90]），而 eGFR 的 AUC 为 0.765（95%CI[0.70-0.83]）。
结论
基线 RDW 升高和 eGFR 降低是增强 CT 后 CA-AKI 的危险因素。RDW 具有良好的预测价值，可作为增强 CT 后发生 CA-AKI 的预警标志物。
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