Contrast-induced Nephropathy in Major Trauma Patients

다국어 초록 (Multilingual Abstract)

Purpose: Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients.
Methods: A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS).
CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation.
Results: One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331).
Conclusion: We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.

참고문헌 (Reference)

1 김종하, "정상 혈청 크레아티닌을 가진 응급실 환자에서의 조영제 연관 신증" 영남대학교 의과대학 32 (32): 90-97, 2015

2 박경아, "전산화단층촬영 조영제 부작용 환자 등록 전산프로그램과 표준진료지침 개발 및 적용 효과" 사단법인 인문사회과학기술융합학회 6 (6): 131-141, 2016

3 신명진, "요오드화 조영제 유해반응의 예방과 치료" 대한의사협회 55 (55): 779-790, 2012

4 박수환, "신장기능이 저하된 급성 관상동맥 증후군 환자에서 조영제 유발 신증의 발생 예측인자" 대한내과학회 82 (82): 185-193, 2012

5 Hipp A, "The incidence of contrast-induced nephropathy in trauma patients" 15 : 134-139, 2008

6 Tremblay LN, "Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine" 59 : 1162-1166, 2005

7 Kim DY, "Is contrast exposure safe among the highest risk trauma patients" 72 : 61-66, 2012

8 Mitchell AM, "Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting" 5 : 4-9, 2010

9 Kim SM, "Incidence and outcomes of contrast-induced nephropathy after computed tomography in patients with CKD : a quality improvement report" 55 : 1018-1025, 2010

10 Elicker BM, "IV contrast administration for CT : a survey of practices for the screening and prevention of contrast nephropathy" 186 : 1651-1658, 2006

11 Vernon DD, "Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims" 103 : 20-24, 1999

12 Marenzi G, "Contrastinduced nephropathy" 7 : s181-3, 2012

13 Marenzi G, "Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction" 44 : 1780-1785, 2004

14 McGillicuddy EA, "Contrast-induced nephropathy in elderly trauma patients" 68 : 294-297, 2010

15 Pucelikova T, "Contrast-induced nephropathy" 71 : 62-72, 2008

16 McCullough PA, "Contrast-induced acute kidney injury" 51 : 1419-1428, 2008

17 Joongyub Lee, "Contrast-Induced Nephropathy in Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography in Korea: A Multi-Institutional Study in 101487 Patients" 대한영상의학회 15 (15): 456-463, 2014

18 Marenzi G, "Contrast volume during primary percutaneous coronary intervention and subsequent contrastinduced nephropathy and mortality" 150 : 170-177, 2009

19 Accessed, "Available"

20 Petrie D, "An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis : Trauma and Injury Severity Score" 41 : 870-875, 1996

21 Adornato B, "Acute renal failure: a complication of cerebral angiography" 33687-33688, 1976

22 Barshay ME, "Acute renal failure in diabetic patients after intravenous infusion pyelography" 1 : 35-39, 1973

23 Brown RC, "Acute renal failure following intravenous cholangiography" 66 : 1142-1144, 1973

24 McCullough PA, "Acute renal failure after coronary intervention : incidence, risk factors, and relationship to mortality" 103 : 368-375, 1997

25 Mehran R, "A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation" 44 : 1393-1399, 2004

26 Harjai KJ, "A comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system" 101 : 812-819, 2008