Fraenkel Yedidah, Bogot Naama R, Kuint Ruth Cytter, Ben-Shalom Efrat, Benjaminov Ofer, Bnaya Alon
Radiology Unit, Clalit Medical Services, Jerusalem, Israel.
The Department of Radiology, Shaare Zedek Medical Center, Affiliated With the Hebrew University, Jerusalem, Israel.
Jpn J Radiol. 2025 Feb;43(2):247-254. doi: 10.1007/s11604-024-01656-7. Epub 2024 Sep 12.
The administration of intravenous (IV) contrast media during computed tomography (CT) examinations is essential to enhance diagnostic accuracy in various clinical scenarios. Traditionally, older age is considered a risk factor for the development of post-contrast Acute Kidney Injury (PC-AKI); however, there is limited information available for the super-elderly population (aged ≥ 85). This study aims to investigate the incidence and risk factors associated with PC-AKI in individuals aged 85 and older undergoing CT scans with IV contrast.
A retrospective cohort study, including all hospitalized patients aged 85 or older who underwent CT scans between the years 2005 and 2021. Patients were categorized into IV contrast and non-IV contrast groups. Baseline demographic and clinical data, along with kidney function parameters, were collected.
The final cohort included 7,078 patients who underwent CT scans, with 40% receiving IV contrast. The overall AKI occurrence within 72 h post-CT was 5.72%, slightly elevated in the non-IV contrast group (6.25% vs. 4.94%, p = 0.02). However, multivariate analysis revealed no significant difference between the groups (OR 1, CI 0.8-1.2, p = 0.92), even after stratifying by kidney function. A secondary analysis, using a less strict AKI definition, supported these findings. Baseline creatinine levels emerged as prominent risk factor associated with PC- AKI.
The current study provides reassurance regarding the safety of contrast-enhanced CT scans in super-elderly patients, particularly those with baseline normal to mild kidney dysfunction. These findings may contribute to the ongoing discussion on the risk-benefit balance of contrast-enhanced CT scans in the super-elderly population.
在计算机断层扫描（CT）检查期间静脉注射（IV）造影剂对于提高各种临床情况下的诊断准确性至关重要。传统上，高龄被认为是造影剂后急性肾损伤（PC-AKI）发生的危险因素；然而，关于超高龄人群（年龄≥85岁）的相关信息有限。本研究旨在调查85岁及以上接受CT扫描并静脉注射造影剂的个体中PC-AKI的发生率及相关危险因素。
一项回顾性队列研究，纳入2005年至2021年间所有85岁及以上住院并接受CT扫描的患者。患者被分为静脉注射造影剂组和非静脉注射造影剂组。收集基线人口统计学和临床数据以及肾功能参数。
最终队列包括7078例接受CT扫描的患者，其中40%接受了静脉注射造影剂。CT检查后72小时内总体急性肾损伤发生率为5.72%，非静脉注射造影剂组略高（6.25%对4.94%，p = 0.02）。然而，多因素分析显示两组之间无显著差异（OR 1，CI 0.8 - 1.2，p = 0.92），即使按肾功能分层后也是如此。使用不太严格的急性肾损伤定义进行的二次分析支持了这些发现。基线肌酐水平是与PC-AKI相关的突出危险因素。
本研究为超高龄患者，尤其是基线肾功能正常至轻度受损的患者进行增强CT扫描的安全性提供了保障。这些发现可能有助于正在进行的关于超高龄人群增强CT扫描风险效益平衡的讨论。
