增强 CT 与急性肾损伤：基于糖尿病状态和肾功能的危险分层。
Contrast-enhanced CT and Acute Kidney Injury: Risk Stratification by Diabetic Status and Kidney Function.
机构信息
From the Kidney Research Center, Department of Nephrology (C.C.L., C.H.C., C.C.H.), Department of Emergency Medicine (Y.L.C., T.H.S.), and Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Chang Gung Memorial Hospital, Linkou, No. 5 Fu-Hsing St, Kweishan, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences (C.C.L., C.H.C., C.C.H.), College of Medicine (Y.L.C., C.J.N., T.H.S.), and Department of Medical Imaging and Radiological Sciences, School of Medicine (Y.C.W.), Chang Gung University, Taoyuan, Taiwan; and Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan (C.J.N., T.H.S.).
出版信息
Radiology. 2023 Jun;307(5):e222321. doi: 10.1148/radiol.222321.
Background Diabetes mellitus may be associated with an increased likelihood of CT contrast material-induced acute kidney injury (CI-AKI), but this has not been studied in a large sample with and without kidney dysfunction. Purpose To investigate whether diabetic status and estimated glomerular filtration rate (eGFR) are associated with the likelihood of acute kidney injury (AKI) following CT contrast material administration. Materials and Methods This retrospective multicenter study included patients from two academic medical centers and three regional hospitals who underwent contrast-enhanced CT (CECT) or noncontrast CT between January 2012 and December 2019. Patients were stratified according to eGFR and diabetic status, and subgroup-specific propensity score analyses were performed. The association between contrast material exposure and CI-AKI was estimated with use of overlap propensity score-weighted generalized regression models. Results Among the 75 328 patients (mean age, 66 years ± 17 [SD]; 44 389 men; 41 277 CECT scans; 34 051 noncontrast CT scans), CI-AKI was more likely in patients with an eGFR of 30-44 mL/min/1.73 m (odds ratio [OR], 1.34; < .001) or less than 30 mL/min/1.73 m (OR, 1.78; < .001). Subgroup analyses revealed higher odds of CI-AKI among patients with an eGFR less than 30 mL/min/1.73 m, with or without diabetes (OR, 2.12 and 1.62; = .001 and .003, respectively), when they underwent CECT compared with noncontrast CT. Among patients with an eGFR of 30-44 mL/min/1.73 m, the odds of CI-AKI were higher only in those with diabetes (OR, 1.83; = .003). Patients with an eGFR less than 30 mL/min/1.73 m and diabetes had higher odds of 30-day dialysis (OR, 1.92; = .005). Conclusion Compared with noncontrast CT, CECT was associated with higher odds of AKI in patients with an eGFR of less than 30 mL/min/1.73 m and in patients with diabetes with an eGFR of 30-44 mL/min/1.73 m; higher odds of 30-day dialysis were observed only in patients with diabetes with an eGFR less than 30 mL/min/1.73 m. © RSNA, 2023 See also the editorial by Davenport in this issue.
背景 糖尿病可能与 CT 造影剂引起的急性肾损伤（CI-AKI）的可能性增加有关，但在有和没有肾功能障碍的大样本中尚未对此进行研究。目的 探讨糖尿病状态和估算肾小球滤过率（eGFR）与 CT 造影剂给药后急性肾损伤（AKI）的发生几率是否相关。材料与方法 本回顾性多中心研究纳入了 2012 年 1 月至 2019 年 12 月期间在两家学术医疗中心和三家地区医院接受对比增强 CT（CECT）或非对比 CT 的患者。根据 eGFR 和糖尿病状态对患者进行分层，并进行亚组特定的倾向评分分析。使用重叠倾向评分加权广义回归模型来估计造影剂暴露与 CI-AKI 之间的关联。结果 在 75328 例患者（平均年龄 66 岁±17[标准差]；44389 例男性；41277 例 CECT 扫描；34051 例非对比 CT 扫描）中，eGFR 为 30-44 mL/min/1.73 m（比值比 [OR]，1.34；<.001）或小于 30 mL/min/1.73 m（OR，1.78；<.001）的患者更有可能发生 CI-AKI。亚组分析显示，与非对比 CT 相比，eGFR 小于 30 mL/min/1.73 m 的患者，无论是否患有糖尿病，发生 CI-AKI 的几率均较高（OR，2.12 和 1.62； =.001 和.003）。在 eGFR 小于 30 mL/min/1.73 m 的患者中，与非对比 CT 相比，仅在 CECT 检查的患者中，糖尿病患者发生 CI-AKI 的几率更高（OR，1.83； =.003）。eGFR 为 30-44 mL/min/1.73 m 的患者中，仅在患有糖尿病的患者中，CI-AKI 的几率更高（OR，1.83； =.003）。eGFR 小于 30 mL/min/1.73 m 且患有糖尿病的患者在 30 天内进行透析的几率更高（OR，1.92； =.005）。结论 与非对比 CT 相比，在 eGFR 小于 30 mL/min/1.73 m 的患者中以及 eGFR 为 30-44 mL/min/1.73 m 的糖尿病患者中，CECT 与 AKI 的发生几率增加相关；仅在 eGFR 小于 30 mL/min/1.73 m 且患有糖尿病的患者中观察到 30 天透析的几率更高。
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