Risk factors for contrast-induced nephropathy and their association with mortality in patients with blunt splenic injuries.
BACKGROUND
Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI.


METHODS
We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality.


RESULTS
CIN was independently associated with body mass index (BMI) ≥ 30 kg/m2(odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality.


CONCLUSIONS
In this study, we found that BMI ≥ 30 kg/m2, ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI.
Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan. Electronic address: hs168hs168@gmail.com.
Ting-Min
TM
Hsieh
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: garytsai@cgmh.org.tw.
Tzu-Hsien
TH
Tsai
Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan. Electronic address: anthony0612@adm.cgmh.org.tw.
Yueh-Wei
YW
Liu
Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan. Electronic address: m93chinghua@gmail.com.
Ching-Hua
CH
Hsieh
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000209:etiology; D000328:Adult; D000740:Anemia / Q000150:complications; D003287:Contrast Media / Q000009:adverse effects*; D048909:Diabetes Complications / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy
D003287:Contrast Media
Angiography; Blunt splenic injuries (BSI); Contrast-enhanced computed tomography (CECT); Contrast-induced nephropathy (CIN); Serum creatinine