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Frequency and determinants of adverse reactions induced by high-osmolality contrast media
R D Moore1, E P Steinberg, N R Powe
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Insights
Adverse reactions to high-osmolality contrast media are common, especially moderate reactions during cardiac catheterization. Diabetes is a key risk factor for severe reactions and contrast-induced nephrotoxicity.
Area of Science:
- Radiology
- Nephrology
- Clinical Pharmacology
Background:
- High-osmolality contrast media (HOCM) are widely used in medical imaging.
- Adverse reactions to HOCM can range from mild to severe, necessitating risk factor identification.
- Patient risk factors for HOCM adverse events include advanced age, diabetes, renal/liver disease, and prior allergic reactions.
Purpose of the Study:
- To determine the incidence and risk factors of adverse reactions to HOCM.
- To classify reaction severity and identify predictors of moderate to severe events.
- To investigate risk factors associated with contrast-induced nephrotoxicity.
Main Methods:
- Prospective study of 795 hospitalized patients undergoing cardiac catheterization, peripheral angiography, or contrast-enhanced CT.
- Patients were selected based on predefined risk factors for adverse reactions.
- Adverse reactions were categorized into mild (Class I), moderate (Class II), and severe (Class III) based on clinical severity.
Main Results:
- Overall reaction rates: Class I (45%), Class II (5.5%), Class III (0.4%).
- Class II reactions were more frequent in cardiac catheterization (25%) versus other procedures (2%).
- Diabetes was the sole significant risk factor for combined Class II and III reactions. Diabetes, furosemide use, and atopy predicted nephrotoxicity.
Conclusions:
- Moderate adverse reactions to HOCM are common, particularly during cardiac catheterization.
- Diabetes mellitus is a significant risk factor for both severe HOCM reactions and contrast-induced nephrotoxicity.
- Underlying renal insufficiency was not found to be a risk factor for contrast-induced nephrotoxicity in this cohort.
Abstract:
To determine the frequency of and risk factors for adverse reactions to high-osmolality contrast media, the authors prospectively studied hospitalized patients undergoing cardiac catheterization. The authors also studied patients undergoing peripheral angiography and contrast material-enhanced computed tomography (CT) of the head or body who met at least one of the following criteria thought to increase the risk of adverse reactions: age of more than 60 years, diabetes, renal or liver disease, concurrent nephrotoxic drug use, or a history of allergic reactions (n = 795). Criteria were defined and used to group adverse reactions into three classes of clinical severity. Overall, class I (mild), class II (moderate), and class III (severe) reactions occurred in 362 (45%), 44 (5.5%), and three (0.4%) patients, respectively. Class II reactions were relatively common (25%) in patients undergoing cardiac catheterization yet were uncommon (2%) in patients undergoing the other three procedures. Nephrotoxicity occurred in 18 of 651 patients who had follow-up creatinine levels obtained at 48-72 hours. With multivariate regression analysis, the only risk factor (P less than .05) for combined class II and III reactions was diabetes. Diabetes, furosemide use, and a history of atopy (odds ratio = 2.8) were associated with nephrotoxicity (P less than .05). Underlying renal insufficiency was not a risk factor for nephrotoxicity.