In their study, Aldjia Hocine and colleagues from CHU-Charleroi, Université Libre de Bruxelles in Belgium, reviewed the cases of 149 patients in the CHU-Charleroi 24-bed medical-surgical ICU who received intra-arterial or intra-venous contrast media (CM) for a CT scan or coronary angiography in a 3-year period. Of the 149 patients aged over 18 and who stayed minimum 3 days in the ICU after the CM infection, 98 received contrast media for CT and 51 for coronary angiography. Daily serum creatinine concentrations and diuresis were measured for 3 days after the injection of CM. No protocol for contrast-associated acute kidney injury (CA-AKI) prevention was applied routinely in the ICU during the study period - only 19.5 % of the patients who developed CA-AKI received preventive therapy.
See Also: An Update From The Contrast Media Safety Committee of the European Society of Urogenital Radiology
Results23 cases of contrast-associated acute kidney injury (CA-AKI) were identified (15.4%). The cases were identified according to the definition proposed by Barrett and Parfrey, namely increase in serum creatinine by 25% from baseline or a minimum of 0.5 mg/dL within 3 days after CM administration. The CA-AKI patients were more likely to require renal replacement therapy and had higher ICU mortality rates. At least one RIFLE urine output criteria was observed in 45 patients (30.2%), and 14 of these 45 patients (31.1 %) developed CA-AKI based on creatinine concentrations. In 30% of these cases, urine output decreased or didn’t change after the increase in creatinine concentrations. The RIFLE urine output criteria had low sensitivity (39.1 %) and specificity (67.9 %) for prediction of CA-AKI, a low positive predictive value of 50 % and a negative predictive value of 87.2 %. The maximal dose of vasopressors before CM was the only independent predictive factor for CA-AKI.
The researchers conclude that the predictive value of RIFLE urine output criteria for the development of CA-AKI based on creatinine concentrations was low, which limits its use for assessing the effects of therapeutic interventions on the development and progression of AKI.