Abstract
BackgroundAngiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not.MethodsA retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy.ResultsAmong 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses.ConclusionsEmergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.
Highlights
Angiography has been conducted as a hemostatic procedure for trauma patients
Acute kidney injury (AKI) following intravascular administration of contrast media is defined by several terms such as contrast-induced nephropathy (CIN), contrast-induced acute kidney injury (AKI) (CI-AKI), or post-contrast AKI (PC-AKI) [9, 10], and nearly 10% of patients who were given considerable amount of contrast media in percutaneous coronary angiography were found to develop PC-AKI [11]
Patient characteristics Among 361,706 trauma patients in the database, 331,709 adult patients were transported directly from the scene, and 230,776 patients were eligible for this study (Fig. 1)
Summary
While several com‐ plications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. While several complications of angiography including tissue necrosis, re-bleeding, and vascular injury [7, 8] have been reported, little is known regarding subsequent kidney injury due to contrast media that is used in angiography for trauma victims. Since the dosage of contrast media administered during emergency angiography for trauma patients is often higher than the amount given for a CT with contrast [13], risks of angiography on kidney function exist, and this potential effect has not been extensively examined among severely injured patients. It should be emphasized that some trauma patients who undergo angiography are likely at higher risk for AKI due to hemodynamic instability and direct traumatic insult to the kidney [14, 15]
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