title: Frequency and determinants of adverse reactions induced by high-osmolality contrast media.
abstract: To determine the frequency of and risk factors for adverse reactions to high-osmolality contrast media, the authors prospectively studied hospitalized patients undergoing cardiac catheterization. The authors also studied patients undergoing peripheral angiography and contrast material-enhanced computed tomography (CT) of the head or body who met at least one of the following criteria thought to increase the risk of adverse reactions: age of more than 60 years, diabetes, renal or liver disease, concurrent nephrotoxic drug use, or a history of allergic reactions (n = 795). Criteria were defined and used to group adverse reactions into three classes of clinical severity. Overall, class I (mild), class II (moderate), and class III (severe) reactions occurred in 362 (45%), 44 (5.5%), and three (0.4%) patients, respectively. Class II reactions were relatively common (25%) in patients undergoing cardiac catheterization yet were uncommon (2%) in patients undergoing the other three procedures. Nephrotoxicity occurred in 18 of 651 patients who had follow-up creatinine levels obtained at 48-72 hours. With multivariate regression analysis, the only risk factor (P less than .05) for combined class II and III reactions was diabetes. Diabetes, furosemide use, and a history of atopy (odds ratio = 2.8) were associated with nephrotoxicity (P less than .05). Underlying renal insufficiency was not a risk factor for nephrotoxicity.
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
authors.forename: E P
authors.initials: EP
authors.lastname: Steinberg
authors.forename: N R
authors.initials: NR
authors.lastname: Powe
authors.forename: R I
authors.initials: RI
authors.lastname: White
authors.forename: J A
authors.initials: JA
authors.lastname: Brinker
authors.forename: E K
authors.initials: EK
authors.lastname: Fishman
authors.forename: S J
authors.initials: SJ
authors.lastname: Zinreich
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000792:Angiography; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D009325:Nausea / Q000139:chemically induced; D009994:Osmolar Concentration; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000139:chemically induced
chemical_list: D003287:Contrast Media