目的:本研究旨在阐明静脉造影CT与急性肾损伤(AKI)和住院死亡率之间的关系。
方法:在这项回顾性观察研究中,我们在CT后48小时内检查了AKI,出院时依赖肾脏替代疗法(RRT),以及接受对比增强CT或非增强CT的患者的院内死亡率。我们进行了1:1的倾向评分匹配,以调整IV造影剂使用和结果之间的关联的混杂因素。根据年龄进行亚组分析,性别,入院时诊断,入住ICU,和先前存在的慢性肾脏病(CKD)。
方法:这项研究使用了2008年至2019年的医疗数据视觉数据库。该数据库是日本最大的商用医院索赔数据库,覆盖日本约45%的急诊医院,它还记录了实验室的结果。
方法:无。
结果:该研究包括144,149例(49,057)和没有(95,092)造影剂暴露的患者,从中产生了43,367对倾向得分匹配的对。在所有患者的倾向评分匹配组之间,暴露于造影剂没有明显的AKI风险(4.6%vs.5.1%;赔率比[OR],0.899;95%CI,0.845-0.958)或RRT依赖的显著风险(0.6%与0.4%;或,1.297;95%CI,1.070-1.574)和住院死亡率的显著获益(5.4%与6.5%;或,0.821;95%CI,0.775-0.869)。在关于先前存在的CKD的亚组分析中,接触造影剂是CKD患者发生AKI的显著风险,但非CKD患者则无显著风险.
结论:在这项大规模观察研究中,IV造影剂与AKI的风险增加无关,但同时对需要紧急入院的患者的院内死亡率显示出有益的影响。
OBJECTIVE: This study aimed to elucidate the association between IV contrast media CT and acute kidney injury (AKI) and in-hospital mortality among patients requiring emergency admission.
METHODS: In this retrospective observational study, we examined AKI within 48 hours after CT, renal replacement therapy (RRT) dependence at discharge, and in-hospital mortality in patients undergoing contrast-enhanced CT or nonenhanced CT. We performed 1:1 propensity score matching to adjust for confounders in the association between IV contrast media use and outcomes. Subgroup analyses were performed according to age, sex, diagnosis at admission, ICU admission, and preexisting chronic kidney disease (CKD).
METHODS: This study used the Medical Data Vision database between 2008 and 2019. This database is Japan\'s largest commercially available hospital-based claims database, covering about 45% of acute-care hospitals in Japan, and it also records laboratory results.
METHODS: None.
RESULTS: The study included 144,149 patients with (49,057) and without (95,092) contrast media exposure, from which 43,367 propensity score-matched pairs were generated. Between the propensity score-matched groups of overall patients, exposure to contrast media showed no significant risk of AKI (4.6% vs. 5.1%; odds ratio [OR], 0.899; 95% CI, 0.845-0.958) or significant risk of RRT dependence (0.6% vs. 0.4%; OR, 1.297; 95% CI, 1.070-1.574) and significant benefit for in-hospital mortality (5.4% vs. 6.5%; OR, 0.821; 95% CI, 0.775-0.869). In subgroup analyses regarding preexisting CKD, exposure to contrast media was a significant risk for AKI in patients with CKD but not in those without CKD.
CONCLUSIONS: In this large-scale observational study, IV contrast media was not associated with an increased risk of AKI but concurrently showed beneficial effects on in-hospital mortality among patients requiring emergency admission.