Clinical Study Of Contrast-Induced Acute Kidney Injury In Patients Undergoing Cerebrovascular Angiography

Objective: To analyze the incidence and the related risk factors of contrast-induced acute kidney injury(CI-AKI)in patients undergoing cerebrovascular angiography or interventional therapy,and evaluate the value of related levels in diagnosing CI-AKI after angiography.Methods: 300 patients of ischemic cerebrovascular disease(ICVD)admitted to the neurological department of Yijishan Hospital from October 2014 to December 2015.Name,gender,age,use of drugs,diabetes,hypertension,coronary heart disease,anemia and the dose of contrast medium(CM)were included.All patients underwent cerebrovascular angiography or interventional therapy,were divided to CI-AKI group or non CI-AKI group based on the baseline of elevated serum creatinine(Scr)above 25% after angiography.All the selected patients used iohexol,an hypotonic contrast agent.Pearson correlation analysis was analyzed the relationship between the related levels and the postoperative Scr level;Multiple Logistic regression model was used to analyze the risk factors associated with the occurrence of CI-AKI,and the diagnostic value was verified on the related levels by receiver operating characteristic(ROC)curve.Results:(1)Of 300 patients,22 cases had CI-AKI,the incidence was 7.33%;(2)Univariate analysis showed that incidence of CI-AKI was associated with pre-operative Cys C(t=5.512,P<0.01),24h-UPRO(t=3.507,P=0.01),dose of CM(t=3.017,P=0.030),diabetes(?~2=15.542,P<0.01),hypertension(?~2=4.570,P=0.033),anemia(?~2=5.565,P=0.021),dose of CM?150m L(?~2=26.041,P<0.01)and the use of no statins(?~2=5.829,P=0.015);(3)Multiple Logistic regression indicated that Cys C,dose of CM?150ml and diabetes were the independent risk factors for occurring CI-AKI(P<0.05);(4)Pearson correlation analysis indicated that post-operative Cys C and 24h-UPRO were positively correlated with post-operative Scr level(P<0.01);(5)ROC curve analysis revealed that the optimal cutoff of Cys C to predict CI-AKI is 1.640 mg/L(AUC=0.828,sensitivity 0.818,specificity 0.722),and the optimal cutoff of 24h-UPRO to predict CI-AKI is 0.096 g/24h(AUC=0.603,sensitivity 0.667,specificity 0.557).Conclusion: Pre-operative CysC level,dose of CM?150ml and diabetes are the independent risk factors for occurring CI-AKI undergoing cerebrovascular angiography or intervention;and the post-operative Cys C level has a higher diagnostic value in CI-AKI.