Renal venous density in the arterial phase of contrast-enhanced CT predicts prognosis in septic shock.

OBJECTIVE

To evaluate a series of vascular parameters derived from abdominal dual-phase contrast-enhanced CT as predictors of 14-day mortality and AKI within 7 days in septic shock.

METHODS

144 patients with septic shock and 60 negative cases were included. The vascular parameters from CT were measured and calculated, including aortic density in arterial (Den-A) and venous phase (Den-V), renal vein density in arterial (Den-A) and venous phase (Den-V), and renal vein-to-aortic density ratio in arterial (DenR-A) and venous phase (DenR-V). The parameters were compared between patients and controls, and between patients with different clinical outcomes, and assessed for predictive value of 14-day mortality and AKI within 7 days.

RESULTS

Patients with septic shock presented significantly lower Den-A ( < 0.001) and DenR-A ( = 0.002) levels than the controls. In the septic shock group, patients who died had significantly lower Den-A ( = 0.001) and lower DenR-A ( < 0.001) than those who survived. Patients who developed AKI had significantly lower Den-A ( < 0.001) and DenR-A ( = 0.011) than those who did not. Multivariate analysis suggested DenR-A as an independent predictor of 14-day mortality (OR 0.012; 95% confidence interval [CI]:0.002,0.086; < 0.001) and Den-A as an independent predictor of AKI (OR 0.989;95% CI:0.982,0.997; = 0.006).

CONCLUSION

In septic shock, significant decreases in Den-A and DenR-A were associated with the onset of AKI and predicted higher 14-day mortality.

ADVANCES IN KNOWLEDGE

The renal vein density and renal vein-aortic density ratio in arterial phase of dual-phase contrast-enhanced CT may serve as good predictors of AKI and mortality in septic shock.