Risk of post-contrast acute kidney injury in emergency department patients with sepsis

Abstract

Campaign, a care bundle of sepsis treatmentincluding fluid resuscitation, antimicrobial therapy, and source control-is recommended as life-saving treatment for patients with sepsis. 2 Computed tomography (CT) scanning is a popular method for ORIGINAL ARTICLE (20 vs 19 days, P=0.742). Conclusions: Intravenous contrast administration during CT scanning was not associated with prolonged length of hospital stay in patients with sepsis in an emergency setting. Moreover, the use of contrast-enhanced CT was not associated with increased risks of acute kidney injury, emergent dialysis, or short-term mortality.

Contrast associated nephropathy after intravenous administration: what is the magnitude of the problem?

“…The majority of published studies showed that mortality was no different in patients who receive CM [8,15,18,19,[48][49][50][51][52][53][54] (Table 1). In-hospital dialysis following IV CM was extremely low in most studies except for reports that analyzed patients with sepsis [8,15,17-20, 48-51,53-55] (Table 1).…”

The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review

“…Of these, studies performed by Huang et al [ 28 ], Brito et al [ 21 ], and Dağar et al [ 12 ] found low incidences of temporary haemodialysis, with no patients requiring permanent haemodialysis. Hsu et al [ 25 ] also had no patients who required chronic dialysis, despite a relatively high incidence of emergent dialysis performed. McGillicuddy et al [ 13 ] had two CIN patients who required permanent dialysis after being discharged, but they only made up 0.3% of patients who underwent CECT in the ED.…”

“…Furthermore, new initiation of dialysis and diagnosis of ESRD at 30 days for CECT patients in the ED were rare among patients with CKD receiving ICM [ 20 ]. Two studies also concluded that ICM administration during CECT in the ED does not increase the risk of emergent dialysis [ 25 , 27 ], diagnosis of CKD, and renal transplantation at 6 months [ 23 ]. While Cho et al [ 24 ] reported five ED patients with CIN after CECT receiving renal replacement therapy, it was initiated due to predisposing conditions such as multiorgan failure instead of ICM exposure.…”

“…However, we have found that CIN is associated with an increased risk of mortality in the ED based on a majority of the articles. Two articles [ 25 , 30 ] reported high incidence of short-mortality rates in their cohort, whereas Dağar et al [ 12 ] and Hong et al [ 18 ] reported no and low mortality respectively. Five studies [ 13 , 20 , 28 , 30 , 32 ] noted that CIN was associated with an increased risk of death, although four studies [ 12 , 18 , 25 , 31 ] contraindicated this finding, whereby their studies revealed no significant differences in mortality rates between the CECT and non-CECT groups.…”

Journal policy on publishing studies with negative results

“…In this issue of the Hong Kong Medical Journal, Hsu et al 5 conducted a study on patients with sepsis who received computed tomography scans with or without contrast media at a tertiary referral centre. The results showed no difference between the two groups in the incidence of AKI, emergent dialysis, mortality, and hospital stay.…”