Haemodynamic consequences of acute pulmonary embolism predict risk of CTPA-related acute kidney injury.

Abstract

Introduction: Computed tomography pulmonary angiography (CTPA) is an important study in the diagnosis of acute pulmonary embolism (APE). There are limited data on acute kidney injury (AKI) after CTPA in APE patients. The aim was to evaluate frequency and predictors of AKI in patients with the first APE episode.

Patients and methods: Single-centre, retrospective analysis of APE patients, without haemodynamic instability. Blood tests, including plasma creatinine concentration and clinical evaluation were performed before CTPA and after 48 and 72 h. Transthoracic echocardiography was performed to evaluate right ventricular (RV) function.

Results: A total of 411 patients with APE were enrolled. AKI defined by creatine increase ≥0.3 mg% within 72 h following CTPA was found in 46 pts (11.2%). Patients with AKI (+) when compared with AKI (-) were characterized by higher sPESI score; more pronounced RV dysfunction; higher plasma concentration of N terminal pro brain natriuretic peptide (NT-proBNP) and more often suffered from pre-existing chronic kidney disease (CKD) and diabetes mellitus (DM2). The multivariate logistic regression model showed that only: BOVA score {odds ratio (OR) 1.431 [95% confidence interval (CI), 1.110; 1.845], P value = 0.006}; NT-proBNP > 3314 pg/mL [OR 3.765 (95% CI, 1.572; 9.016), P value = 0.003], while not CKD or sPESI were independent risks factors for AKI. Among subjects with BOVA ≥ 3 points and NT-proBNP ≥ 3314 pg/mL, almost 32% developed AKI, and among patients with BOVA < 3 points and NT-proBNP < 3314 pg/mL, only 5% of patients developed AKI.

Conclusions: AKI present in 11% of all PE patients diagnosed with CTPA is associated with embolism severity, measured by BOVA score, and RV dysfunction as defined by higher NT-proBNP, while not to pre-existing CKD or DM2.