Incidence of Contrast-Associated Acute Kidney Injury in Renal-Competent COVID-19 Patients Undergoing Computed Chest Angiography.
Incidence of Contrast-Associated Acute Kidney Injury in Renal-Competent COVID-19 Patients Undergoing Computed Chest Angiography.
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DOI：
10.1097/rct.0000000000001337
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发表时间：
2022-09-01
影响因子：
1.3
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中科院分区：
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COVID-19感染具有肾损伤和肺栓塞的重大风险，这给临床带来了挑战，因为肺栓塞的标准检查计算机断层血管造影（CTA）需要使用肾毒性碘化造影剂。我们的研究评估了无肾损害实验室证据的症状性covid -19阳性患者发生对比剂相关急性肾损伤（CA-AKI）的风险是否增加。对2020年3月1日至12月10日在某顶级三级医疗中心接受胸部非对比ct和CTA检查的所有covid -19阳性患者进行回顾性评估。共有258例肾功能正常（估计肾小球滤过率bbb30）的患者，其基线和检查后48至72小时肌酐测量值被确定并分析符合CA-AKI标准的急性肾损伤（AKI）发生率。191例接受CTA的患者中有25例（13.1%），67例接受非对比计算机断层扫描的患者中有9例（13.4%）的肌酐升高符合CA-AKI的标准。考虑已知AKI危险因素的单因素和多因素分析显示，碘造影剂与符合CA-AKI标准的AKI发生率之间没有相关性（单因素优势比为0.97[95%可信区间，0.43-2.20]；多因素优势比为0.97[95%可信区间，0.40-2.36]）。肾功能正常的COVID-19患者接受胸部CTA可能不会增加AKI的风险。需要进一步的研究来证实这一初步发现。
COVID-19 infection poses a significant risk of both renal injury and pulmonary embolism, producing a clinical challenge, as the criterion standard examination for pulmonary embolism, computed tomography angiography (CTA), requires the use of nephrotoxic iodinated contrast agents. Our investigation evaluated whether symptomatic COVID-19–positive patients without laboratory evidence of renal impairment are at increased risk for developing contrast-associated acute kidney injury (CA-AKI). All COVID-19–positive patients undergoing noncontrast chest computed tomography and CTA at an apex tertiary medical center between March 1 and December 10, 2020, were retrospectively evaluated. A total of 258 renal-competent (estimated glomerular filtration rate >30) patients with baseline and 48- to 72-hour postexamination creatinine measurements were identified and analyzed for incidence of acute kidney injury (AKI) meeting the criteria for CA-AKI. Twenty-five of 191 patients undergoing CTA (13.1%) and 9 of the 67 undergoing noncontrast computed tomography (13.4%) experienced creatinine increases meeting the criteria for CA-AKI. Univariate and multivariate analyses accounting for known AKI risk factors revealed no correlation between iodinated contrast administration and the incidence AKI meeting the criteria for CA-AKI (univariable odds ratio, 0.97 [95% confidence interval, 0.43–2.20]; multivariable odds ratio, 0.97 [95% confidence interval, 0.40–2.36]). Renal-competent COVID-19 patients undergoing chest CTA may not have an increased risk of AKI. Additional studies are needed to confirm this preliminary finding.