title: Risk stratification nomogram for nephropathy after abdominal contrast-enhanced computed tomography.
abstract: OBJECTIVE
  Abdominal contrast-enhanced computed tomography (A-CECT) is widely used in emergency departments despite the risk of contrast-induced nephropathy. We attempted to develop a risk stratification nomogram for nephropathy in patients receiving emergency A-CECT.
  
  
  METHODS
  Seven hundred fifty patients who received emergency A-CECT between August 2003 and January 2007, with available serum creatinine (SCr) measurements before and after A-CECT were included. Nephropathy was defined as either an absolute increase of 0.5 mg/dL or greater (44 μmol/L) or a relative increase of 25% or more in the SCr from baseline. A nomogram was developed based on multivariate logistic regression analysis using clinical variables available before A-CECT. The model was internally validated with a bootstrapping method, and performance was assessed by area under the receiver operating characteristics curve (AUC) and calibration curve.
  
  
  RESULTS
  Nephropathy was observed in 34 of 750 patients. A nomogram was developed using age (odds ratio, 1.04 per 1-year increment) and baseline SCr (odds ratio, 2.51 per 1-mg/dL increment) as risk factors. Diagnostic accuracy of the model was fair by bias-corrected calibration plot. The AUC of the model was 0.794 (95% confidence interval, 0.734-0.854), and the AUC with bootstrapping samples of 200 repetitions was 0.794 (95% confidence interval, 0.737-0.851).
  
  
  CONCLUSIONS
  The risk of nephropathy after emergency A-CECT can be individually predicted by internally validated nomogram using clinical variables available before the procedure.
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung Su
authors.initials: KS
authors.lastname: Kim
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.forename: Seung Sik
authors.initials: SS
authors.lastname: Hwang
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Lee
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Kim
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Suh
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Hye Duk
authors.initials: HD
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011237:Predictive Value of Tests; D012372:ROC Curve; D011860:Radiography, Abdominal / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007472:Iohexol; C038192:iopromide; D003404:Creatinine; D007479:Iopamidol