M Manoj, Sandhu Manavjit Singh, Gupta Pankaj, Samanta Jayanta, Sharma Vishal, Kumar Vivek, Mandavdhare Harshal, Dutta Usha, Kochhar Rakesh
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2023 Dec;42(6):808-817. doi: 10.1007/s12664-023-01415-y. Epub 2023 Aug 14.
The data evaluating contrast-induced-acute kidney injury (AKI) in patients with acute pancreatitis is scarce. This study aimed to compare the frequency of AKI in patients with acute necrotizing pancreatitis undergoing non-contrast computed tomography (NCCT) with those undergoing contrast-enhanced computed tomography (CECT) during hospitalization.
This prospective randomized controlled trial (CTRI/2019/12/022206) screened consecutive patients with acute pancreatitis for eligibility and randomly allocated patients with acute necrotizing pancreatitis (based on CECT in the first week of illness) and normal renal functions to receive either NCCT or CECT during hospitalization. The incidence of development of new AKI and clinical outcomes was compared between the two groups. Post-hoc analysis was done to adjust for disease severity.
As many as 105 patients completed the study as per protocol (NCCT = 45 and CECT = 60). AKI occurred in 36 (34.3%) patients, nine (20%) in the NCCT and 27 (45%) in the CECT group. Contrast induced-AKI occurred in 11 (18.3%) patients, while 25 had AKI secondary to acute pancreatitis. The relative risk (RR) of AKI in the CECT group was 2.25 (95% CI 1.17-4.30, p = .0142). The frequency of intensive care unit (ICU) admission (RR = 2.1, 95% CI 1.34-3.27, p = .0001) and need for drainage of collections (RR = 1.39, 95% CI 1.1-1.7, p = .005) was significantly higher and the length of hospitalization (p = .001) and ICU admission (p = 0.001) were significantly longer in the CECT group. However, when adjusted for the severity of acute pancreatitis, there was no difference in AKI and clinical outcomes between the NCCT and CECT groups. The duration of AKI was significantly longer and the need for dialysis was significantly higher in patients who had AKI secondary to acute pancreatitis compared to those with contrast induced-AKI (p = .003).
CECT is not significantly associated with AKI in acute necrotizing pancreatitis.
评估急性胰腺炎患者对比剂诱导的急性肾损伤（AKI）的数据较少。本研究旨在比较住院期间接受非增强计算机断层扫描（NCCT）与增强计算机断层扫描（CECT）的急性坏死性胰腺炎患者发生AKI的频率。
这项前瞻性随机对照试验（CTRI/2019/12/022206）对连续的急性胰腺炎患者进行筛选以确定其是否符合条件，并将急性坏死性胰腺炎患者（根据疾病第一周的CECT结果）且肾功能正常的患者随机分配，使其在住院期间接受NCCT或CECT检查。比较两组中新发AKI的发生率和临床结局。进行事后分析以调整疾病严重程度。
多达105例患者按方案完成了研究（NCCT组=45例，CECT组=60例）。36例（34.3%）患者发生AKI，其中NCCT组9例（20%），CECT组27例（45%）。对比剂诱导的AKI发生在11例（18.3%）患者中，而25例患者的AKI继发于急性胰腺炎。CECT组发生AKI的相对风险（RR）为2.25（95%CI 1.17-4.30，p=0.0142）。CECT组重症监护病房（ICU）入院频率（RR=2.1，95%CI 1.34-3.27，p=0.0001）和需要引流积液的频率（RR=1.39，95%CI 1.1-1.7，p=0.005）显著更高，且住院时间（p=0.001）和ICU住院时间（p=0.001）在CECT组显著更长。然而，在调整急性胰腺炎的严重程度后，NCCT组和CECT组在AKI和临床结局方面没有差异。与对比剂诱导的AKI患者相比，继发于急性胰腺炎的AKI患者的AKI持续时间显著更长，透析需求显著更高（p=0.003）。
在急性坏死性胰腺炎中，CECT与AKI无显著相关性。
