gms | German Medical Science

Objectives: Contrast enhanced whole body CT is more and more routinely performed for the initial evaluation of severely injured patients. The nephrotoxic effects of the intravenous contrast agent have been well investigated in patients undergoing coronary angiography. However, little is known about the contrast-induced acute kidney injury in trauma patients.

The primary goal of this study was to determine the prevalence of CIN at a Level I trauma center. Further, independent risk factors for the development of CIN and the clinical implications were investigated.

Methods: The electronic medical records of all trauma patients admitted to the resuscitation area of our Level I trauma center between 2008 and 2014 were retrospectively reviewed. Inclusion criteria were pre-clinical intubation and i.v. contrast enhanced whole body CT at admission. Exclusion criteria were missing initial serum creatinine levels (SCr) or missing follow up levels within 72 hours. Two hundred and eighty four patients with a mean age of 47 years met the criteria and were further analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute increase of > 44 µmol/l within 72 hours. Bivariate and multivariable regression analyses were performed to identify significant risk factors. All p-values < 0.1 were included in logistic regression analysis. A p-value < 0.05 was considered statistically significant.

Results: Forty one patients (14%) met the criteria for CIN. Six patients (15%) had hemodialysis in the CIN-group and 8 (3.3%) in the group without CIN. Mortality rate was 32% in patients with and 23% in patients without CIN. Older age (OR 1.02), new hemi-/para-/tetraplegia (OR 5.9) and pre-existing musculo-skeletal diseases (OR 4.5) were identified as independent risk factors for CIN. CIN itself significantly increased the risk for hemodialysis (OR 4.8). However, CIN was not a risk factor for mortality nor complications while controlling for concomitant injuries, comorbidities, age, and sex. The length of stay was also not affected by CIN.

Conclusion: The incidence of CIN (14%) was slightly higher compared to other studies. This is possibly due to our inclusion criteria, since only severely injured patients were included in our study.

We found age, plegia and muskulo-skeletal diseases as risk factors for CIN. CIN itself did however not affect in-hospital outcome except for hemodialysis.