title: Incidence and outcome of contrast-associated acute kidney injury in a mixed medical-surgical ICU population: a retrospective study.
abstract: BACKGROUND
  Contrast-enhanced radiographic examinations carry the risk of contrast-associated acute kidney injury (CA-AKI). While CA-AKI is a well-known complication outside the intensive care unit (ICU) setting, data on CA-AKI in ICU patients are scarce. Our aim was to assess the incidence and short-term outcome of CA-AKI in a mixed medical-surgical ICU population.
  
  
  METHODS
  We conducted a single-center retrospective analysis between September 2006 and December 2008 on adult patients who underwent a contrast-enhanced computed tomography for urgent diagnostic purposes. CA-AKI was defined as either a relative increment in serum creatinine of ≥ 25% or an absolute increment in serum creatinine of ≥ 0.3 mg/dL within 48 hrs after contrast administration. ICU mortality rates of patients with and without CA-AKI were compared in univariate and multivariate analyses. The need for renal replacement therapy (RRT) was also recorded.
  
  
  RESULTS
  CA-AKI occurred in 24/143 (16.8%) patients. Coexisting risk factors for kidney injury, such as sepsis, nephrotoxic drugs and hemodynamic failure were commonly observed in patients who developed CA-AKI. ICU mortality was significantly higher in patients with than in those without CA-AKI (50% vs 21%, p = 0.004). In multivariate logistic regression, CA-AKI remained associated with ICU mortality (odds ratio: 3.48, 95% confidence interval: 1.10-11.46, p = 0.04). RRT was required in 7 (29.2%) patients with CA-AKI.
  
  
  CONCLUSIONS
  In our cohort, CA-AKI was a frequent complication. It was associated with a poor short-term outcome and seemed to occur mainly when multiple risk factors for kidney injury were present. Administration of ICM should be considered as a potential high-risk procedure and not as a routine innocuous practice in ICU patients.
authors: Medical-surgical Intensive Care Unit, Service de réanimation, Hôpital Avicenne, Avicenne teaching Hospital, 125 Route de Stalingrad, Bobigny Cedex 93009, France. christophe.clech@avc.aphp.fr
authors: Christophe
authors: C
authors: Clec'h
authors: Dominique
authors: D
authors: Razafimandimby
authors: Mehdi
authors: M
authors: Laouisset
authors: Frank
authors: F
authors: Chemouni
authors: Yves
authors: Y
authors: Cohen
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
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