title: The incidence and significance of acute kidney injury following emergent contrast administration in patients with STEMI and stroke.
abstract: The authors have investigated the incidence of acute kidney injury (AKI) and short-term mortality following an activated STEMI and stroke alert at a tertiary referral and academic center. A single center, retrospective chart review of STEMI and stroke activation patients from January 2010 to March 2012. Data was collected and reviewed from an institutional database following IRB-approval. Inclusion criteria were STEMI patients taken for cardiac catheterization, excluding patients receiving hemodialysis due to end-stage renal disease (ESRD). Primary outcome measures were the incidence of AKI using the RIFLE criteria and short-term mortality. 745 patients were included (488 stroke, 257 STEMI). The median age was 65, and 39 % were female. Overall inpatient mortality was 7.0 %. 5.4 % (40/745) of patients experienced some degree of AKI (8.6 % of STEMI, 3.7 % of stroke patients). Overall, 30 % of patients with AKI died during their hospitalization. AKI was associated with a 7.1-fold (95 % CI 3.4-15.1) increase in mortality in the entire cohort. Among STEMI patients, AKI was associated with a 66.6-fold (95 % CI 12.9-343.4) increase in mortality. These findings follow similar trends published among critically ill patients with AKI. The risk of death with concomitant AKI in this hospital population is significant and deserves future study. Early recognition and awareness in the emergency department is paramount to the patient's survival. Future studies should focus on modalities to improve early recognition and preventative therapies.
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL, 32610, USA. marchick@ufl.edu.
authors.forename: Michael Robert
authors.initials: MR
authors.lastname: Marchick
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL, 32610, USA.
authors.forename: Brandon Russell
authors.initials: BR
authors.lastname: Allen
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL, 32610, USA.
authors.forename: Emily Cassin
authors.initials: EC
authors.lastname: Weeks
authors.affiliation: Department of Health Outcomes and Policy Biostatistics Epidemiology and Research Design, Clinical and Translational Science Institute, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL, 32610, USA.
authors.forename: Jonathan Jacob
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL, 32610, USA.
authors.forename: Marie-Carmelle
authors.initials: MC
authors.lastname: Elie
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D061605:Administration, Intravenous; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects* / Q000627:therapeutic use; D003404:Creatinine / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007472:Iohexol / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000401:mortality; D020521:Stroke / Q000150:complications* / Q000401:mortality; D014283:Triiodobenzoic Acids / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; D003404:Creatinine; C044834:iodixanol
keywords: Acute kidney injury; CVA; Intravenous contrast; STEMI