May 18, 2017
This was a retrospective cohort analysis of 184, 875 patients with an infection-related primary admission diagnosis in 182 Australian and New Zealand intensive care units (ICUs) from 2000 through 2015. The aim of the study was to determine if an increase of 2 or more points in the SOFA score have greater prognostic accuracy in patients who are critically ill with suspected infection than 2 or more points in the SIRS criteria or qSOFA score points. The primary outcome was in-hospital mortality. In-hospital mortality or ICU length of stay (LOS) of 3 days or more was a composite secondary outcome. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Adjusted analyses were performed using a model of baseline risk determined using variables independent of the scoring systems. Conclusion: An increase in SOFA score of 2 or more had greater prognostic accuracy for in-hospital mortality in ICU patients than SIRS criteria or the qSOFA score suggesting that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting.
Bottom Line: This was a single center, retrospective cohort study at an academic hospital from 2009-2014 to determine if IV contrast for CT increased the risk for primary outcome of acute kidney injury and secondary outcomes of CKD, Dialysis, renal transplant at 6 months. Essentially, how often does AKI occur after CT scan with and without contrast? 16,801 patients studied who started with creatinine between 0.4 and 4.0. Logistic regression modeling was used with propensity scoring to test for independent association of contrast administration and the primary and secondary outcomes. There was no significant differences between AKI rates, even among patients with worse baseline renal function. There was also no significant increased CKD, dialysis, or renal transplant at 6 months for patients who received IV contrast. The results suggest that the use of IV contrast for CT scanning is not associated with nephrotoxic effects with the laboratory-based outcome of AKI and the other patient-centered outcomes measured. As Emergency Physicians, we should have less hesitancy or reluctance to obtain potentially life-saving IV contrast CT imaging when indicated.
Bottom line: This was a single-center retrospective, computerized chart review at an academic hospital from 2005-2010 to determine if IV contrast causes death or dialysis and if contrast induced nephropathy was higher in the patients who received IV contrast. There were 6,954 patients admitted to the hospital who received IV contrast, and initial creatinine of less than 1.6. There was no significant difference in deaths, dialysis, or contrast induced nephropathy among the group that received IV contrast or just plain CT. All the patients in the study who underwent dialysis (0.3% vs 0%) had a significant medical problem requiring surgery or other critical illness. For patients admitted to the hospital with normal renal function, IV contrast did not have any associated negative consequences. Further studies are needed, including a prospective, randomized, blinded, well-controlled trial..
Improving Journal Club Presentations, or, I can present that paper in under 10 minutes, Schwartz et al, Evidence Based Medicine, 2007