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Incidence and outcome of contrast-associated acute kidney injury in a mixed medical-surgical ICU population: a retrospective study.

Abstract : ABSTRACT: BACKGROUND: Contrast-enhanced radiographic examinations carry the risk of contrast-associated acute kidney injury (CA-AKI). While CA-AKI is a well-known complication outside the intensive care unit (ICU) setting, data on CA-AKI in ICU patients are scarce. Our aim was to assess the incidence and short-term outcome of CA-AKI in a mixed medical-surgical ICU population. METHODS: We conducted a single-center retrospective analysis between September 2006 and December 2008 on adult patients who underwent a contrast-enhanced computed tomography for urgent diagnostic purposes. CA-AKI was defined as either a relative increment in serum creatinine of >= 25% or an absolute increment in serum creatinine of >= 0.3 mg/dL within 48 hrs after contrast administration. ICU mortality rates of patients with and without CA-AKI were compared in univariate and multivariate analyses. The need for renal replacement therapy (RRT) was also recorded. RESULTS: CA-AKI occurred in 24/143 (16.8%) patients. Coexisting risk factors for kidney injury, such as sepsis, nephrotoxic drugs and hemodynamic failure were commonly observed in patients who developed CA-AKI. ICU mortality was significantly higher in patients with than in those without CA-AKI (50% vs 21%, p = 0.004). In multivariate logistic regression, CA-AKI remained associated with ICU mortality (odds ratio: 3.48, 95% confidence interval: 1.10-11.46, p = 0.04). RRT was required in 7 (29.2%) patients with CA-AKI. CONCLUSIONS: In our cohort, CA-AKI was a frequent complication. It was associated with a poor short-term outcome and seemed to occur mainly when multiple risk factors for kidney injury were present. Administration of ICM should be considered as a potential high-risk procedure and not as a routine innocuous practice in ICU patients.
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Submitted on : Friday, April 26, 2013 - 5:07:12 PM
Last modification on : Wednesday, August 19, 2020 - 11:21:19 AM
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Christophe Clec'H, Dominique Razafimandimby, Mehdi Laouisset, Frank Chemouni, Yves Cohen. Incidence and outcome of contrast-associated acute kidney injury in a mixed medical-surgical ICU population: a retrospective study.. BMC Nephrology, BioMed Central, 2013, 14 (1), pp.31. ⟨10.1186/1471-2369-14-31⟩. ⟨inserm-00818383⟩

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