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Prevalence and outcome of contrast-induced nephropathy in major trauma patients
Julian Alexander Kelemen1, Alexander Kaserer2, Kai Oliver Jensen1
1Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091, Zurich, Switzerland.
Insights
Contrast-induced nephropathy (CIN) affects 14% of trauma patients but is not an independent risk factor for mortality. Contrast-enhanced CT scans are safe for trauma patients, despite the risk of CIN.
Area of Science:
- Radiology
- Nephrology
- Trauma Surgery
Background:
- Contrast-induced nephropathy (CIN) is well-studied in angiography but not in trauma patients.
- This study investigates CIN prevalence and risk factors in major trauma patients.
Purpose of the Study:
- Determine the prevalence of CIN in trauma patients.
- Identify independent risk factors for CIN development in this population.
Main Methods:
- Retrospective analysis of 284 pre-hospital intubated trauma patients (2008-2014).
- CIN defined by serum creatinine increase (>25% or >44 µmol/l) within 72 hours.
- Univariate and multivariable regression analyses were performed.
Main Results:
- CIN prevalence was 14% (41/284 patients).
- Age and lactate levels showed suggestive evidence of influencing CIN.
- CIN patients had higher complication (71% vs 56%) and mortality (32% vs 23%) rates, but CIN was not an independent risk factor.
Conclusions:
- CIN is frequent in trauma patients but not an independent predictor of complications or mortality.
- Contrast-enhanced whole-body CT is deemed safe for trauma patients.
Background:
Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN.
Methods:
Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01-0.049 suggested evidence.
Results:
Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN.
Conclusion:
CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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