在计算机断层扫描中引起对比的急性损伤风险:一项16个机构的回顾性队列研究
Byungjin Choi1, Subin Heo, Jennifer S Mcdonald
1From the Department of Biomedical Informatics, Ajou University Graduate School of Medicine, Suwon, South Korea (B.C., S.S., S.G., B.P., R.W.P.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H., S.H.C., S.H.P.); Department of Radiology, Mayo Clinic Rochester, Rochester, MN (J.S.M.); Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (W.-M.C.); Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.B.L.); Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (E.A.L.); Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea (B.P.); Department of Nephrology, Ajou University School of Medicine, Suwon, South Korea (H.J.C.); Department of Radiology, Keimyung University, Dongsan Hospital, Daegu, South Korea (B.J.K.); Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea (S.Y.R.); Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (S.B.H.); Division of Cardiology, Incheon Sejong Hospital, Incheon, South Korea (K.-H.K.); Department of Radiology, School of Medicine, Catholic University of Daegu, South Korea (Y.H.L.); and Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Chungcheongnam-do, South Korea (S.S.K.).
对于大多数患者来说,计算机断层扫描 (CT) 的对比诱导急性损伤 (CI-AKI) 风险是最小的. 然而,患有慢性病或低EGFR的个体面临风险增加,需要仔细考虑对比媒介的使用.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 放射学 放射学是一门学科.
- 医疗成像医学成像
背景情况:
- 对比诱导的急性损伤 (CI-AKI) 是计算机断层扫描 (CT) 成像中的一个问题.
- 了解CI-AKI的确切风险和诱导因素对于患者护理至关重要.
研究的目的:
- 为了确定CI-AKI的风险,在对比度增强CT扫描后进行CT扫描.
- 在接受CT的患者中识别CI-AKI的诱发性风险因素.
主要方法:
- 使用来自韩国16个机构 (2006年1月至2022年12月) 的电子病历进行了1:1倾向分数匹配分析.
- 对18岁以上的患者进行了对比增强和非增强CT扫描的分析.
- 基线估计的淋巴细胞过率 (eGFR),人口统计和临床变量被匹配,以评估CI-AKI风险.
主要成果:
- 在182,170个与对比度增强和非增强CT扫描相匹配的CT扫描中,CI-AKI的整体风险在统计学上并不显著 (OR,1.036;P = 0.34).
- 在EGFR<30毫升/分钟/1.73米2 (OR,1.176;P=0.011) 或EGFR30-45毫升/分钟/1.73米2 (OR,1.139;P=0.019) 的患者中观察到显著更高的CI-AKI风险.
- 患有慢性脏病的患者 (OR,1.215;P=0.011) 和接受异体对比介质的患者 (OR,1.392;P=0.011) 也显示CI-AKI风险增加.
结论:
- 在CT后的CI-AKI风险在一般人群中是最小的.
- 建议在患有慢性病和eGFR低于45mL/min/1.73m2.2.的患者时谨慎使用.
- 在风险患者群体中,使用异体对比介质需要仔细考虑.
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