Is There A Relationship Between Acute Kidney Injury and Use of Enhanced Computed Tomography in Septic Patients Presenting to An Emergency Center?

Kim, Chang Yob; Lee, Jae Hoon

Abstract

PURPOSE
Computed tomography (CT) with contrast media (CM) is often performed on patients with elevated serum creatinine (sCr), however, due to the risk of contrast induced nephropathy (CIN), the confirmatory use of intravenous contrast CT is not routine. This aim of this study was to differentiate between pre-renal acute kidney injury (AKI) due to severe sepsis and CIN.
METHODS
Of 330 patients with sepsis who presented to an emergency center in a tertiary care hospital and who underwent CT from January 2009 until May 2010, 232 were enrolled in this study. A group of 115 septic patients with CM and a group of 117 septic patients without CM were analyzed.
RESULTS
When considering the change according to difference in initial sCr, the 2~3 day increase of serum creatinine (sCr) observed in both groups did not differ significantly (p=0.236). Use of CM and the amount of iodine showed no significant association with AKI within a period of three days (p=0.64 and p=0.558, respectively). Regardless of the use of CM, elevated sCr at the time of hospital presentation was likely to lead to elevated sCr at day 2-3 (odds ratio 4, p=0.034).
CONCLUSION
CIN can be confused with other causes, particularly renal failure due to sepsis. The effect of performing intravenous contrast CT on the kidney may be less than thought. The risk of checking intravenous contrast CT, which was delayed for prevention of renal impairment in patients with elevated sCr, should be reconsidered.