Analysis Of Risk Factors Of Acute Adverse Reaction To Iodinated Contrast Media

Background and Objective:Iodinated contrast media(ICM)has been extensively used to improve medical imaging and is the indispensable medicine for radiological diagnostics.With the sustainable development of medical imaging equipment and the increasing use of ICM,the adverse reactions to ICM are also increasing.What factors are related to the incidence and severity of acute adverse reactions(AARs)to ICM? The relevant literature has been reported,but the conclusion is still controversial.Moreover,the results of prospective and retrospective studies are a little different.For clinicians,it is important to identify the general characteristics of AARs related to ICM and understand the common risk factors of AARs.AARs related to ICM can be categorized as physiologic reactions and allergic-like reactions.Allergic-like reactions are related to the body’s own reactions,and studies on the nature of allergic-like reactions have been ongoing.Some scholars have established the correlation and diagnostic value between IgE,peripheral blood eosinophils(EOS)and allergic diseases.However,the correlation between the patient’s baseline total IgE level,peripheral blood EOS level,and ICM acute allergic-like reaction has not been yet clear.Besides,in daily clinical practice,before the CT enhanced examination,the patients routinely fasted for 4-6 hours or longer.During the fasting process,the patient’s blood glucose will change.Whether blood glucose is related to the acute allergic-like reaction of the iodine contrast agent needs to be explored.The study of the correlation between patients’ baseline total IgE level,EOS level,blood glucose level,and ICM acute allergic-like reaction has important clinical significance.So,the purpose of this study is twofold.Firstly,we aimed to identify the incidence,types,general characteristics,and risk factors of AARs related to ICM according to the ICM drugs used.Secondly,we tried to preliminarily investigate the correlation between the patient’s baseline total IgE level,peripheral blood EOS level,immediate blood glucose level and ICM acute allergic-like reaction.Materials and Methods:Patients who underwent contrast-enhanced CT examinations between October2020 and December 2020 in our hospital were prospectively included.The patients`baseline information,CT enhanced examination data,clinical data,and AARs data related to ICM were all collected.After signing the informed consent,the immediate blood glucose of the subjects before ICM administration was tested,and 3ml blood samples of the subjects were collected to test their baseline total IgE and EOS levels.AARs related to ICM are classified and graded according to the latest version of the2020 ACR Contrast Media manual.The incidence,types,and general characteristics of AARs related to ICM were summarized.Logistic regression was used to analyze the independent risk factors of AARs related to ICM.The differences,such as baseline IgE,peripheral blood EOS,immediate blood glucose,between the negative group of allergic-like reaction and the positive group were compared.Among the patients who had IgE previously tested,all the patients with allergic-like reactions were designated as the case group.A control group was selected among patients without allergic-like reactions,after matching for independent risk factors of AARs related to ICM.Next,the independent predictive effect of IgE,EOS,and blood glucose on acute allergic-like reactions was analyzed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive accuracy.Results:A total of 1462 patients were enrolled,and 62 of them developed AARs.The total incidence of AARs releated to ICM was 4.24%,and the incidence of acute allergic-like reactions was 1.37%.Univariate logistics regression analysis showed that the higher injection flow rate(OR=2.634,P<0.05),coronary CT angiography(CCTA)examination(OR=0.481,P<0.05),hyperlipidemia(OR=3.500,P<0.05),a history of adverse reaction to ICM(OR=35.542,P<0.05),a history of various allergies(OR=2.963,P<0.05),the lower baseline creatinine level(OR=0.980,P<0.05)were important risk factors for AARs related to ICM.Multivariate logistic regression analysis showed that hyperlipidemia(OR=4.148,P<0.05),cardiac insufficiency(OR=3.022,P<0.05),a history of contrast media adverse reaction(OR=12.936,P<0.05),and a history of various allergies(OR=3.384,P<0.05)were the independent risk factors for AARs related to ICM.The comparison showed that the baseline IgE(Z=-3.869,P<0.001)and the peripheral blood EOS(Z=-2.504,P=0.012)in the positive group of allergic-like reaction were higher than those in the negative group,and the difference was statistically significant.There was no significant difference in immediate blood glucose between the two groups(Z=-0.298,P=0.766).After matching the case group with the ratio of 1:4 to the control group,it was found that the baseline IgE level was an independent predictor of acute allergic-like reaction.There is no clear correlation between peripheral blood EOS level,immediate blood glucose level and acute allergic-like reaction.The ROC curve showed that the cut-off value was 143.25 IU/ml,and the AUC was 0.923(95%CI:0.835-1.000,P=0.045).The sensitivity of baseline IgE levels to predict acute allergic reactions was 88.9%,and the specificity was 83.3%.Conclusions:1.The total incidence of AARs to ICM was 4.24%,and the incidence of acute allergic reactions was 1.37%.2.Hyperlipidemia,cardiac insufficiency,previous history of adverse reaction to ICM,and history of various allergies are independent risk factors for AARs related to ICM.3.The patients` baseline IgE level is closely related to the occurrence of acute allergic-like reactions to ICM and is an independent predictor of the occurrence of acute allergic-like reactions to ICM.There is no clear correlation between peripheral blood EOS level,immediate blood glucose level and acute allergic-like reaction.