Slagter, E.M. (2014) (Contrast)nefropathie bij polytraumapatiënten. thesis, Medicine.
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Abstract
Background. The Total Body CT scan of trauma patients demonstrates many advantages, e.g. a reduction of the number of missed diagnoses and a decrease of retention time within the trauma room. However, the administration of contrast medium may lead to an increase of incidence of contrast-induced nephropathy. Literature concerning this topic is scarce and lacking to answer this question. The aim of this study is to determine the incidence of (contrast-induced) nephropathy among polytraumatized patients. Furthermore, it discusses the relation between the administration of contrast medium and the development of (contrast-induced) nephropathy. Method. All trauma patients with an Injury Severity Score (ISS) >15, who have been treated during 2004 to 2012 at the emergency department of the University Medical Centre Groningen, are included in this study. Children and transferred patients were excluded. The patient’s medical records were reviewed to collect data. (Contrast-induced) nephropathy was defined according to the following definition: an increase of serum creatinine-concentration by at least 25% or by at least 44 μmol/L with respect to the baseline within 72h after infusion of contrast medium or within 72h after admission to the hospital. Missing data has been imputed. Using the logistic regression analysis, an association model was constructed to describe the relation between the administration of contrast medium and the development of (contrast-induced) nephropathy. Results. In total, 1363 patients were studied, with an average age of 47,8 (+/- 19,9 years), 75,2% were men. Considering patients without any risk factor (diabetes mellitus, heart failure, pre-existing renal failure or age >60), no significant relation between the administration of contrast medium and the development of (contrast-induced) nephropathy has been observed. This relation has been corrected for rhabdomyolysis, kidney injury, hemodynamic instability, and baseline creatinine-concentration. The incidence of nephropathy among this group was 13,4%. Without the infusion of contrast medium the incidence was 10,3%. Considering patients with one or more risk factors, the administration of contrast medium leads to a 3,5 times higher odds to develop nephropathy. The incidence of nephropathy among this group after the infusion of contrast medium was 32,7%. Without the administration of contrast medium the incidence was 12,2%. Conclusion. Almost 1 out of 3 patients with diabetes mellitus, heart failure, pre-existing renal failure and/or older age developed nephropathy after the administration of contrast medium. The association model demonstrates that the odds for developing nephropathy after infusion of contrast medium are 3,5 times higher compared to the odds for developing nephropathy without contrast medium. For patients without risk factors the odds to develop nephropathy after the infusion of contrast medium remains the same.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | El Moumni, M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/950 |
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