Associations of Increases in Serum Creatinine with Mortality and Length of Hospital Stay after Coronary Angiography

Abstract

The absence of a universally accepted definition of radiocontrast nephropathy (RCN) has hampered efforts to characterize effectively the incidence and the clinical significance of this condition. The objective of this study was to identify a clinically relevant definition of RCN by assessment of the relationships between increases in serum creatinine (Scr) of varying magnitude after coronary angiography and clinical outcomes. An electronic medical database was used to identify all patients who underwent coronary angiography at the University of Pittsburgh Medical Center during a 12-yr period and abstract Scr levels before and after angiography, as well as demographic characteristics and comorbid conditions. Changes in Scr after angiography were categorized into mutually exclusive categories on the basis of absolute and relative changes from baseline levels, with a separate category denoting "unknown" change. Discrete proportional odds models were used to examine the association between increases in Scr and 30-d in-hospital mortality and length of stay. A total of 27,608 patients who underwent coronary angiography were evaluated. Small absolute (0.25 to 0.5 mg/dl) and relative (25 to 50%) increases in Scr were associated with risk-adjusted odds ratios for in-hospital mortality of 1.83 and 1.39, respectively. Larger increases in Scr generally were associated with greater risks for these clinical outcomes. Small increases in Scr after the administration of intravascular radiocontrast are associated with adverse patient outcomes. This observation will help guide the postprocedure care of patients who undergo coronary angiography and has important implications for future studies that investigate RCN.

Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

“…11 Contrast-induced AKI has serious prognostic implications; it is linked to increases in length of hospital stay and to higher rates of in-hospital cardiovascular events, inhospital mortality, and 1-year and 5-year mortality rates. 5,9,[12][13][14] Even relatively small changes in renal function after administration of contrast medium are associated with substantial increases in mortality rates 14 ; this finding suggests that renal insufficiency is a sensitive marker of poor outcomes for patients at risk or perhaps that transient episodes of renal ischemia may produce secondary hemodynamic or vascular changes in other organs. 15 The materials cited in this review include recent guidelines and published reports of clinical trials of contrastinduced AKI and its prevention.…”

Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

“…T he intravascular administration of iodinated contrast media is a well-recognized cause of acute kidney injury, which in turn, is associated with in-hospital morbidity and mortality (1)(2)(3)(4). Clinical factors that increase the risk for contrast-induced acute kidney injury (CIAKI) include preexistent kidney disease, diabetes mellitus in the setting of underlying renal impairment, advanced congestive heart failure, intravascular volume depletion, administration of large volumes of contrast, and the use of high-osmolal contrast media (1,(5)(6)(7)(8).…”

Risks and Complications of Coronary Angiography: Contrast Related Complications

“…For instance the recent definition of AKI, considers a 0.3 mg/dl increase of serum creatinine as an evidence of AKI development rather than a 0.5 mg/dl increase (Shah & Mehta, 2006). Weisbord etal showed that only a 0.25-0.3 mg/dl increase in serum creatinine after coronary angiography was accompanied with significant increase of mortality within 30 days of procedure (Weisbord etal., 2006). In another study only a 5% increases of serum creatinine within 12 hours after the contrast exposure had 75% sensitivity and 72% specificity for detecting CIN.…”