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急诊 CT 扫描:揭示造影剂相关急性肾损伤的风险。

Emergency CT Scans: Unveiling the Risks of Contrast-Associated Acute Kidney Injury.

机构信息

Department of Emergency Medicine, Izmir Şehir Hospital, 35540 Izmir, Türkiye.

Department of Emergency Medicine, Izmir Democracy University, 35140 Izmir, Türkiye.

出版信息

Tomography. 2024 Jul 11;10(7):1064-1073. doi: 10.3390/tomography10070080.

Abstract

OBJECTIVES

This study aimed to identify the incidence and risk factors for contrast-associated acute kidney injury nephropathy (CA-AKI) in patients undergoing contrast-enhanced computed tomography (CCT) in the emergency department.

MATERIALS AND METHODS

In this retrospective single-center study, patients aged 18 and older who visited the emergency department and underwent CCT between January and February 2022 were included. The Mehran score, calculated from patient data, was used to assess risk. CA-AKI development was determined by measuring serum creatinine (SCr) levels 48-72 h post-contrast administration.

RESULTS

The study included 532 patients, with a mean age of 57 ± 19 years; 53.2% were male. CA-AKI developed in 16% of cases, 5.82% required hemodialysis, and 7.9% died. The Mehran score was the only significant predictor of CA-AKI development. Patients with a Mehran score of 16 or higher had a 161-fold increased risk of developing CA-AKI compared to those with a score of 5 or lower. The model achieved a 91.3% correct classification rate. Logistic regression analysis showed that CA-AKI significantly increased mortality risk by 15.7 times.

CONCLUSION

The Mehran score, originally developed for predicting CA-AKI risk post-coronary intervention, is also effective for predicting CA-AKI risk after CCT. While CA-AKI is a significant factor affecting mortality, it is not the sole cause of death (Nagelkerke R2 value 0.310).

摘要

目的

本研究旨在确定在急诊科行增强计算机断层扫描(CCT)的患者中造影剂相关急性肾损伤肾病(CA-AKI)的发生率和危险因素。

材料与方法

在这项回顾性单中心研究中,纳入了 2022 年 1 月至 2 月期间在急诊科就诊并接受 CCT 的年龄在 18 岁及以上的患者。使用从患者数据计算的 Mehran 评分来评估风险。通过测量造影后 48-72 小时的血清肌酐(SCr)水平来确定 CA-AKI 的发生情况。

结果

该研究共纳入 532 例患者,平均年龄为 57±19 岁,53.2%为男性。16%的患者发生了 CA-AKI,5.82%需要血液透析,7.9%死亡。Mehran 评分是 CA-AKI 发生的唯一显著预测因素。Mehran 评分在 16 分或以上的患者发生 CA-AKI 的风险是评分在 5 分或以下的患者的 161 倍。该模型的正确分类率为 91.3%。Logistic 回归分析表明,CA-AKI 使死亡率显著增加了 15.7 倍。

结论

最初用于预测冠状动脉介入术后 CA-AKI 风险的 Mehran 评分,也可有效预测 CCT 后 CA-AKI 的风险。虽然 CA-AKI 是影响死亡率的重要因素,但不是死亡的唯一原因(Nagelkerke R2 值为 0.310)。

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