Abstract 2696: Contrast Induced Nephropathy Is Associated With Poor Outcomes In IV t-PA Treated Patients

Abstract

Background: Given the rise in the use of multimodal Computerized Tomography (CT) including CT angiography (CTA) and CT Perfusion (CTP) for acute ischemic stroke(AIS), there has been growing concern about Contrast induced nephropathy (CIN). Reduced renal function has been shown to be an independent prognostic factor in cerebrovascular disease and long term mortality. The purpose of this study was to assess the impact of CIN on clinical outcome in AIS patients treated with IV t-PA. Methods: We performed a retrospective chart review of our prospectively gathered stroke registry and identified patients who were treated with IV t-PA and underwent a CTA and/or CTP as part of their acute stroke evaluation from 1/07 to 6/11. CIN was defined as rise of Creatinine over baseline by 25% within 3 days of contrast administration. Outcome measure was discharge mRS. We compared outcomes in those with CIN to patients that did not develop CIN. Multivariable logistic regression was built with factors that had p<.2 on univariate analysis. All tests were two-sided and P-values <.05 were considered significant. Results: We identified 200 patients meeting our criteria; 10 patients developed CIN. Baseline demographics and risk factors are shown in the table . We found that there were statistically significant differences in baseline NIHSS (p= 0.030) and in death at discharge, (p=0.035) between patients who developed CIN and those who did not. CIN was significantly associated with death at discharge after adjustment for NIHSS (odds ratio [OR]= 4.78; 95% CI,1.06-21.46, p=0.04). In addition, patients with NIHSS ≥ 15 were more likely to develop CIN with OR of 5.14 [95% CI 1.28-20.58 (p = 0.02)]. Of note, all of the patients who developed CIN had eGFR ≥ 60. Conclusion: Development of CIN after multimodal CT in AIS patients treated with IV t-PA is associated with worse clinical outcomes after adjusting for stroke severity. Patients with NIHSS >15 in our dataset, despite normal renal function, were at risk for CIN. Because of the retrospective nature and small sample size of our study, we might have missed confounding variables that are associated with mortality in patients who developed CIN. However, with the increased use of CTA/P in AIS evaluation, a prospective study is needed to assess the predictors and impact of CIN on clinical outcome in patients treated with IV t-PA.