Emergency angiography for trauma patients and potential association with acute kidney injury

Abstract Background Angiography 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 em...

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Autores principales:	Ryo Yamamoto, Ramon F. Cestero, Jo Yoshizawa, Katsuya Maeshima, Junichi Sasaki
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Angiography Embolization Hemostasis Acute kidney injury Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/94f995b2dd5f48bd87cbabfbc1426434
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spelling	oai:doaj.org-article:94f995b2dd5f48bd87cbabfbc14264342021-11-08T11:14:50ZEmergency angiography for trauma patients and potential association with acute kidney injury10.1186/s13017-021-00400-01749-7922https://doaj.org/article/94f995b2dd5f48bd87cbabfbc14264342021-11-01T00:00:00Zhttps://doi.org/10.1186/s13017-021-00400-0https://doaj.org/toc/1749-7922Abstract Background Angiography 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. Methods A 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. Results Among 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. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.Ryo YamamotoRamon F. CesteroJo YoshizawaKatsuya MaeshimaJunichi SasakiBMCarticleAngiographyEmbolizationHemostasisAcute kidney injurySurgeryRD1-811Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENWorld Journal of Emergency Surgery, Vol 16, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Angiography Embolization Hemostasis Acute kidney injury Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Angiography Embolization Hemostasis Acute kidney injury Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Ryo Yamamoto Ramon F. Cestero Jo Yoshizawa Katsuya Maeshima Junichi Sasaki Emergency angiography for trauma patients and potential association with acute kidney injury
description	Abstract Background Angiography 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. Methods A 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. Results Among 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. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.
format	article
author	Ryo Yamamoto Ramon F. Cestero Jo Yoshizawa Katsuya Maeshima Junichi Sasaki
author_facet	Ryo Yamamoto Ramon F. Cestero Jo Yoshizawa Katsuya Maeshima Junichi Sasaki
author_sort	Ryo Yamamoto
title	Emergency angiography for trauma patients and potential association with acute kidney injury
title_short	Emergency angiography for trauma patients and potential association with acute kidney injury
title_full	Emergency angiography for trauma patients and potential association with acute kidney injury
title_fullStr	Emergency angiography for trauma patients and potential association with acute kidney injury
title_full_unstemmed	Emergency angiography for trauma patients and potential association with acute kidney injury
title_sort	emergency angiography for trauma patients and potential association with acute kidney injury
publisher	BMC
publishDate	2021
url	https://doaj.org/article/94f995b2dd5f48bd87cbabfbc1426434
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Emergency angiography for trauma patients and potential association with acute kidney injury

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