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J Korean Soc Emerg Med > Volume 28(1); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(1): 40-46.
Contrast-induced Nephropathy in Major Trauma Patients
Young Ah Jang, Jeong Ho Park, Seung Pill Choi, Jung Hee Wee
Department of Emergency Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence  Jung Hee Wee ,Tel: 02-3779-1778, Fax: 02-761-8440, Email: beautydoc21@naver.com ,
Received: October 12, 2016; Revised: October 17, 2016   Accepted: December 8, 2016.  Published online: February 28, 2017.
Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients.
A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS). CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation.
One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331).
We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.
Key words: Contrast nephropathy, Tomography, X-ray computed, Trauma
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