• Chest · Mar 2014

    Frequency of contrast induced nephropathy in patients who undergo computed tomography pulmonary angiography for pulmonary embolism.

    • Omar Aly, Erik Vakil, Mohammad Kousha, and Genese Lamare.
    • Chest. 2014 Mar 1;145(3 Suppl):524A.

    Session TitleDVT/PE PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Computed tomography with contrast of the pulmonary arteries (CTPA) is the most commonly used test to evaluate and diagnose pulmonary embolism (PE) in the Emergency Department (ED) setting. Contrast induced nephropathy (CIN) is a concerning sequela of contrast based studies. The aim of this study was to assess the frequency of CIN in patients undergoing CTPA in the ED setting.MethodsWe conducted a retrospective chart review of all patients who underwent CTPA for evaluation of PE in a single center, tertiary care ED from Jan 1 - Dec 31 2010. Serum creatinine (sCr) values both pre and post-CTPA were reviewed. Our primary endpoint was the development of CIN, defined as an absolute increase in sCr of ≥0.5 mg/dL or relative increase of ≥25% compared to baseline sCr within 48 hours of contrast exposure. Patients with end stage renal disease were excluded. As a secondary endpoint, we looked at whether specific comorbidities were associated with an increased incidence of CIN.ResultsA total of 1677 patients (mean age 57.2 +/- 16.5 years, 64.4% female) underwent CTPA over the year-long study period. Overall PE was diagnosed in 6.5% (95% CI: 5.3% - 7.7%). Post-CTPA sCr values were obtained in 601 patients, and 11.5% of patients with paired sCr developed CIN (95% CI: 8.9% - 14.0%). When looking at other comorbidities, CHF was the only comorbidity associated with an increased incidence of CIN (odds ratio 3.58, 95% CI 1.77 - 7.24, p <0.0001).ConclusionsThe incidence of CIN was high in our study despite a low overall diagnostic yield of CTPA for PE. Additionally, patients with CHF may be at increased risk of developing CIN after CTPA.Clinical ImplicationsThe high rate of CIN suggests that providers need to carefully weigh the risks of CTPA prior to obtaining this test. Adjunctive testing and/or use of scoring systems may better define a population where the potential benefit of CTPA outweighs the risks.DisclosureThe following authors have nothing to disclose: Omar Aly, Erik Vakil, Mohammad Kousha, Genese Lamare, A. Shorr, Chee ChanNo Product/Research Disclosure Information.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…