J. Saluck1,2, A. A. Fokin2, J. Wycech2,3, A. Tymchak1,2,3, M. Gomez3, M. Crawford2, I. Puente1,2,3,4 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
Incidence of contrast-induced nephropathy (CIN) has been reported in 1.9%-9.8% among different subgroups of trauma patients. However, the consequences of serial administration of contrast medium during angiography and repeat contrast computed tomography (CT) in patients with kidney trauma (KT) have not been sufficiently studied. The purpose of this study was to evaluate the incidence and predictors of contrast induced nephropathy (CIN) in patients with KT and to assess the effect of CIN on clinical outcomes.
Methods:
This IRB approved retrospective cohort study included adult patients, admitted to a level 1 trauma center between 2012 and 2017 who received contrast, 86 patients with a KT, and 224 with abdominal organ injuries (AOI), other than the kidney.
In the KT cohort, 10 (11.6%) developed CIN (CIN KT Group), while 76 (88.4%) did not (No-CIN KT Group). In our AOI cohort, 21 (9.4%) developed CIN and 203 (91.6%) did not. CIN was defined as relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 72 hours of contrast administration. Age, Injury Severity Score (ISS), Kidney Organ Injury Scale (KOIS) Grade, rates of transfusion of blood products, angiography, embolization, repeat abdominal CT, hemoperitoneum, intensive care unit length of stay (ICULOS), hospital LOS (HLOS) and mortality were compared between CIN KT and No-CIN KT Groups.
Results:
Of the patients who developed CIN in KT cohort, 60.0% had an absolute increase in serum creatinine within 72 hours of contrast administration and 40.0% had a relative increase.
CIN KT and No-CIN KT Groups showed no significant difference in age (50.0 vs 44.8 years. p=0.6), ISS (27.4 vs 21.4, p=0.4), and KOIS Grade (2.4 vs 2.1, p=0.2). Both Groups, also had comparable rates of angiography (20.0% vs 17.1%, p=0.8), embolization (10.0% vs 3.9%, p=0.4), and repeat CT (40.0% vs 39.5%, p=1.0). With 100.0% of patients in CIN KT Group and 68.4% in No-CIN KT Group requiring a stay in the ICU, the difference in ICULOS between the two Groups did not reached statistical difference (9.8 vs 6.6 days, p=0.05).
CIN KT compared to No-CIN KT Group, had statistically higher rate of blood product transfusions (80.0% vs 46.1%, p=0.04) and detection of hemoperitoneum on CT (100.0% vs 55.3%, p=0.007). CIN KT patients had a statistically longer HLOS (14.2 vs 9.6 days, p=0.04), but mortality was not statistically different (20.0% vs 10.5%, p=0.4).
Conclusion:
Low grade kidney trauma did not increase incidence of CIN in patients with abdominal injuries. Higher rates of blood transfusions and hemoperitoneum detected on CT were risk factors associated with the occurrence of CIN in patients with kidney injury. Patients that developed CIN had longer HLOS, but not higher mortality.