Prevalence and outcome of contrast-induced nephropathy in major trauma patients

Abstract

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.

The Incidence of Contrast Induced Nephropathy in Major Trauma Patients in the University Clinical Center of the Republic of Srpska

“…Most of the research about CIN have been performed in patients undergoing percutaneous coronary interventions (PCI) (McCullough et al, 1997). Cause of creatinine increase in severely injured patients can be multifactorial e.g., hemorrhagic shock, blood transfusions, injury mechanism, rhabdomyolysis advanced age (Kelemen et al, 2022).…”

“…In a retrospective cohort study conducted in Zurich, 14% of patients had CIN (Kelemen et al, 2022). This study was conducted over a long period of time, included 284 patients, was performed in the trauma center of the first degree and referred to polytraumatized patients who were intubated at admission and with a significantly high ISS.…”

“…Contrast enhanced whole-body CT is more and more routinely performed for the initial evaluation of severely injured patients (Gordic et al, 2015). Although there is an increased risk, there are few studies that analyze the incidence and clinical significance of CIN in polytraumatized patients (Kelemen et al, 2022).…”

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

“…iodinated contrast, in the absence of another etiology. 1 Contrast-induced acute kidney injury has previously been reported as the third leading cause of iatrogenic renal insufficiency, although historically reported incidence of CI-AKI was unclear because of variable definitions for AKI and lack of control groups. 2 , 3 Nonetheless, AKI associated with contrast administration increases hospital length of stay (LOS), mortality rate, and the likelihood for the need for renal replacement therapy (RRT).…”

“…Contrast-induced acute kidney injury (CI-AKI), previously known as contrast-induced nephropathy, is a clinical entity defined by acute kidney injury (AKI) following the administration of intravenous (i.v.) iodinated contrast, in the absence of another etiology 1 . Contrast-induced acute kidney injury has previously been reported as the third leading cause of iatrogenic renal insufficiency, although historically reported incidence of CI-AKI was unclear because of variable definitions for AKI and lack of control groups 2,3 .…”