The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis.

Abstract

Estimates of the risks associated with the use of radiologic contrast agents frequently are based on a subjective review of some of the numerous articles that have been published on the subject. We have chosen instead to synthesize the existing evidence in an objective, quantitative way by statistically combining the data from individual studies through meta-analysis. Although meta-analysis is subject to whatever biases may exist in the underlying data, and may inappropriately pool data from studies with significant differences, the estimates draw proportionately from each original study and, in addition, gain considerable precision owing to the increased amounts of data considered. Using this technique, we analyzed the data from all available original reports appearing since 1980. Crude rates derived from all reports were used to estimate risks with high-osmolality media. Weighted rate differences based on comparative studies only were used in the estimation of the reductions in risk obtainable with low-osmolality media. The risk of death with high-osmolality media was 0.9 per 100,000 uses (95% confidence interval, 0.3-2.6 per 100,000). The difference in risk produced by using lowosmolality media was 0 (95% confidence interval,-1.1 to 1.1 per 100,000). The risk of severe reactions associated with high-osmolality media was 157 per 100,000 uses (95% confidence interval, 144-172 per 100,000). The reduction in risk that can be obtained by the use of low-osmolality media was estimated to be 126 per 100,000 (95% confidence interval, 1 10-142 per 100,000). This meta-analysis shows that the risk of death is very low with either type of contrast material and that there is no difference between them. Severe nonfatal reactions with high-osmolality media, although more frequent, are still rare; approximately 80% of them can be prevented by using low-osmolality media.

Patient Requests for Office-Based Imaging

“…When intravenous dye is used for imaging, there is a significant risk of kidney toxicity-ranging from 1% to greater than 10% depending on the population and type of imaging procedure [21,22]. There is also a small but real risk of kidney toxicity contributing to, or directly causing, mortality-ranging from 9 deaths per 100,000 for all CT scans using contrast to up to 0.6% for certain populations scanned in an emergency department [22,23].…”

Radiologic Imaging of Renal Masses

“…Severe reactions occur in less than 0.1% of patients, and it is estimated that 80% of these may be avoided by use of low osmolar contrast media. [109,110] All contrast-associated risks appear to be lowered by use of low osmolar contrast media currently available. Administration of prophylactic corticosteroids and use of low osmolar contrast media have been shown to decrease the risk of contrast reaction, but not eliminate it.…”

Living Renal Donors: Optimizing the Imaging Strategy—Decision- and Cost-effectiveness Analysis

“…estimated the morbidity and mortality associated with various strategies (31,32,35) and the morbidity associated with laparoscopic nephrectomy (39) on the basis of data from the literature. Since a reliable estimate for mortality associated with laparoscopic donor nephrectomy was not available, it was assumed to be the mortality associated with open nephrectomy (6).…”