Acute kidney injury following contrast media administration in the septic patient: A retrospective propensity-matched analysis

• Published in: Journal of critical care Vol. 51; pp. 111 - 116
• Main Authors: Hinson, Jeremiah S., Al Jalbout, Nour, Ehmann, Michael R., Klein, Eili Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; Acute kidney injury; Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Administration, Intravenous; Adult; Aged; AIDS; Baltimore - epidemiology; Contrast agents; Contrast media; Contrast Media - administration & dosage; Contrast Media - adverse effects; Contrast-induced nephropathy; Critical care; Diabetes; Emergency Service, Hospital; Female; Heart failure; HIV; Human immunodeficiency virus; Humans; Hypertension; Iatrogenesis; Incidence; Intensive care; Kidney diseases; Male; Medical imaging; Middle Aged; Mortality; Patients; Propensity Score; Retrospective Studies; Sepsis; Sepsis - diagnostic imaging; Tomography, X-Ray Computed; Variables; Baltimore; Sepsis; Acute kidney injury; Contrast media; Contrast-induced nephropathy
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.02.003

To determine the risk for acute kidney injury (AKI) attributable to intravenous contrast media (CM) administration in septic patients. This was a single-center retrospective propensity matched cohort analysis performed in the emergency department (ED) of an academic medical center. All visits for patients ≥18 years who met sepsis diagnostic criteria and had serum creatinine (SCr) measured both on arrival to the ED and again 48 to 72 h later were included. Of 4171 visits, 1464 patients underwent contrast-enhanced CT (CECT), 976 underwent unenhanced CT and 1731 underwent no CT at all. The primary outcome was incidence of AKI. Logistic regression and between-groups odds ratios with and without propensity-score matching were used to test for an independent association between CM administration and AKI. Incidence of AKI was 7.2%, 9.4% and 9.7% in those who underwent CECT, unenhanced CT and no CT. CM administration was not associated with increased incidence of AKI. Sepsis is a medical emergency proven to benefit from early diagnosis and rapid initiation of treatment, which is often aided by CECT. Our findings argue against withholding CM for fear of precipitating AKI in potentially septic patients.