Emergency angiography for trauma patients and potential association with acute kidney injury

Abstract

Background Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

Acute kidney injury development in polytrauma and the safety of early repeated contrast studies: A retrospective cohort study

“…This finding has been previously reported with angioembolization being found to not increase the risk of AKI in trauma patients 29 . However, a potential risk for AKI with angiography has been demonstrated with an incidence rate of 1.1% compared with 0.5% ( p < 0.01) in a cohort of 230,776 patients 34 …”

“…29 However, a potential risk for AKI with angiography has been demonstrated with an incidence rate of 1.1% compared with 0.5% ( p < 0.01) in a cohort of 230,776 patients. 34 As expected, AKI within our cohort was linked to an increase in mortality, MOF, LOS in both ICU and hospital, and need for RRT. These are well-defined outcomes for trauma patients developing AKI.…”

“… 29 However, a potential risk for AKI with angiography has been demonstrated with an incidence rate of 1.1% compared with 0.5% ( p < 0.01) in a cohort of 230,776 patients. 34 …”

Spontaneous renal cyst rupture in a female patient: A case report

“…A partial nephrectomy may be necessary when the renal tissue is unviable. In the lack of possibility to preserve the renal tissue, total nephrectomy should be beneficial [7] , [8] . Moreover, nephrectomy is a primary treatment for malignant tumors [5] .…”

Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy

“…In addition, the administration of iodinated contrast material before surgery may also pose a risk for renal damage. In one study, it was shown that angiography increases the risk of renal damage in emergency trauma patients [ 3 ]. In another study, it was concluded that the time of angiography before coronary bypass did not affect postoperative renal failure in diabetic patients [ 4 ].…”