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The incidence of contrast-induced nephropathy in trauma patients

Hipp, Antonia; Desai, Shoma; Lopez, Carmen; Sinert, Rich

European Journal of Emergency Medicine:
doi: 10.1097/MEJ.0b013e328270367d
Original Articles
Abstract

Background: We measured the incidence and risk factors for contrast-induced nephropathy (CIN) in trauma patients.

Methods: We conducted a retrospective review of a prospectively collected trauma database. We studied injured patients who received a contrast-enhanced computer tomography with an initial and repeat serum creatinine after 48 h. Exclusion criteria were patients on dialysis. CIN was defined as a 25% rise in creatinine or an increase in creatinine ≥0.5 mg/dl from baseline 48 h after contrast. Data were reported as means±SD. Group comparisons were made by Fisher's exact test or Student's t-test (α=0.05, two tails).

Results: In total, 235 patients were studied with an average age of 44±20 (13–92 years) (80% men), 79% of whom had blunt injuries. CIN incidence was 5.1% [95% confidence interval (CI), 2.9–8.8%]. No patients in the CIN or non-CIN groups died, or required in-patient/chronic dialysis. CIN patients were significantly (P=0.003) older (61 vs. 43 years). For age ≥75 years, the relative risk was 7.7 and the number needed to harm was 5. An elevated creatinine (more than 1.5 mg/dl) was significantly (P=0.007) associated with CIN. For creatinine greater than 1.5 mg/dl, the relative risk was 6.4 and the number needed to harm was 6. CIN was significantly (P=0.02) more likely in patients with glomerular filtration rate less than 60 ml/min/1.73 m2. We found no significant (P>0.05) difference in base-deficit, lactate, and Injury Severity Score between CIN and non-CIN patients.

Conclusion: We found a 5.1% incidence of CIN in trauma patients exposed to intravenous contrast. Elderly and trauma patients with low glomerular filtration rate were especially predisposed to CIN.

Author Information

Department of Emergency Medicine, State University of New York, Downstate Medical Center, New York, USA

Correspondence to Antonia Hipp, DO, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York – Downstate Medical Center, Box 1228, 450 Clarkson Avenue, Brooklyn, NY 11203, USA

Tel: +1 718 245 2973; fax: +1 718 245 4799;

e-mail: antonia424@earthlink.net

Presented as an Oral Presentation European Society of Emergency Medicine Crete, Greece, October 2006.

Received 8 February 2007 Accepted 9 April 2007

© 2008 Lippincott Williams & Wilkins, Inc.