Incidence and risk factors of contrast-associated acute kidney injury in patients hospitalised after contrast-enhanced computed tomography in the Emergency Department

Incidence and risk factors of contrast-associated acute kidney injury in patients hospitalised after contrast-enhanced computed tomography in the Emergency Department | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence and risk factors of contrast-associated acute kidney injury in patients hospitalised after contrast-enhanced computed tomography in the Emergency Department Elodie Lecomte, Pradeebane Vaittinada Ayar, Valérie Vilgrain, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7357786/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Dec, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background Since 1930 it has been accepted that intravenous injection of iodinated contrast agent as part of contrast-enhanced computed tomography (CE-CT) imaging can induce a contrast-associated acute kidney injury (CA-AKI). For the last 10 years, studies have investigated this iatrogenia. However, those works didn’t concern French population and particularly patient hospitalised after emergency department (ED) visit. This study assessed the CA-AKI incidence and factor risks in patients hospitalised after a CE-CT in ED. Material and Methods This was a monocentric retrospective study, conducted in a University Hospital ED (Beaujon Hospital) between 2019 and 2022. Patients over 16 years old who received a CE-CT and two serum creatinine dosages, one pre-CT and one post-CT (2 to 7 days later), were included. Risk factors and protective factors of CA-AKI as well as population characteristics were analysed. Results After studying 5079 enhanced CT-scans, 1463 patients fulfilled the inclusion criteria. The incidence of CA-AKI was 4.1%. The associated risk factors were: hypertension (adjusted odds ratio (aOR) = 3.36, 95% confidence interval (CI) (1.76–6.43)), CKD grade 4–5 (aOR = 5.89, 95% CI (1.39–24.95)), waiting time before CT (aOR = 3.36, 95% CI (1.76–6.43)). Ongoing treatment by metformin was found to be a protective factor (aOR = 0.26, 95% CI (0.06–1.12)). Conclusion It appeared that only hypertension and CKD grade 4–5 were risk factors for CA-AKI. Their absence would allow performing a CE-CT without waiting for kidney function levels. This consideration could reduce patient length of stay and the associated morbidity and mortality. Acute kidney injury contrast media tomography Contrast-induced nephropathy Figures Figure 1 1. Background The use of iodinated contrast agents dates back to 1901, initially with lipid-soluble formulations and later with water-soluble agents for vascular injection [ 1 ]. Early studies raised concerns about their potential nephrotoxicity, leading to caution in their use [ 2 – 5 ]. Despite advancements in contrast agents, many studies have attempted to elucidate this tubular toxicity. However, due to limitations in sample size, statistical power, ethical considerations, and pathophysiological arguments (based on animal or post-mortem studies) [ 6 ], the belief in contrast-induced acute kidney injury (CI-AKI) has persisted, resulting in routine pre-imaging kidney function tests and prolonged stays in emergency departments. Research has shown that overcrowding in emergency departments increases patient morbidity and mortality, delays critical treatments, and complicates overall emergency care [ 7 , 8 ]. Reducing unnecessary tests, such as routine pre-imaging kidney function assessments, could help shorten hospital stays and improve efficiency. Several large-scale studies conducted between 2013 and 2023 have challenged the notion that intravenous (IV) iodinated contrast significantly increases the risk of acute kidney injury in acute settings. Studies [ 9 , 10 ] found no significant link between IV iodinated contrast use and kidney injury. In 2021, in Taiwan, a large retrospective cohort study in ED observed a mild short-term risk but no long-term impact [ 11 ]. In 2022, a meta-analysis concluded that withholding contrast-enhanced imaging due to nephrotoxicity concerns is not justified for most patients [ 12 ]. Recent studies in intensive care unit confirmed that contrast-enhanced imaging did not worsen kidney function, even in patients with pre-existing AKI [ 13 ] and did not determine any increased risk of AKI or long-term decline in renal function when iodine contrast media is used [ 14 ]. Preventive hydration did not change the risk of CI-AKI [ 15 , 16 ], also in patients with eGFR < 30 mL/min/1.73 m 2 intravenous hydration before and after intravenous administration of iodine contrast media is not associated with lower risks in CI-AKI, chronic dialysis at discharge, and in-hospital mortality [ 17 ]. Updated guidelines have also reflected this understanding shift. The European Society of Urogenital Radiology (ESUR) in 2018 redefined contrast-induced nephropathy while maintaining cautious recommendations [ 18 ]. In 2020, the CIRTACI (Comité interdisciplinaire de recherche et de travail sur les agents de contraste en imagerie) committee renamed CI-AKI as "contrast-associated acute kidney injury" (CA-AKI), emphasizing the lack of proven causality [ 19 ]. The main risk factors identified remain severe kidney disease (eGFR < 30 mL/min/1.73 m2 ) and dehydration, rather than the contrast agents themselves. This study aimed to assess the incidence and the factors associated to CA-AKI in hospitalised patient after ED visit. The objective is to provide further evidence supporting the safety of contrast-enhanced computed tomography (CE-CT), which could help eliminate unnecessary pre-imaging tests, reduce hospital overcrowding, and improve patient management in emergency settings. 2. Methods 2.1. Study Design This was a retrospective cohort observational study in the ED of the Beaujon University Hospital between October 31st 2019 to January 24th 2022. Patients over 16 years old who presented to the emergency department and underwent an intravenous contrast-enhanced CT were eligible. To be included, patients were required to have at least two creatinine measurements: one taken within 24 hours before CT and a second measurement taken between 48 hours to the seventh day following the initial test. The CT examination had to be performed at Beaujon Hospital with the injection of iodinated contrast agents such as IOMERON® (iomeprol) or XENETIX® (iobitridol). Patients were excluded from the study if they did not have two creatinine measurements meeting the specified criteria. If multiple contrast-enhanced CT examinations were performed within a seven-day period for the same patient, only the first examination was included in the study, while subsequent scans were excluded. Repeated CE-CT within 7 days consequences were not evaluated in this study because there were few patients and it was not the purpose of the study. The collected imaging data were extracted from the PACS (Carestream Health, Inc., 2022. CAT 600 0500 02/22). Laboratory and consultation data were extracted from the Orbis® medical data processing system (Agfa Healthcare). The collected data included demographic, qualitative, and quantitative information. An additional analysis was conducted to assess patient outcomes after their emergency department visit. Data were accessed for research purposes from January 24th 2022 to December 31st 2022. The demographic data collected included age and sex. The quantitative data included vital signs recorded by the emergency department triage nurses. The documented parameters included the triage score, systolic blood pressure, heart rate, temperature, respiratory rate, oxygen saturation, Glasgow Coma Scale score. Biological parameters included serum potassium, urea levels, serum sodium, protein levels, haemoglobin levels. The qualitative data were factors previously identified as risk factors for CA-AKI in prior studies[ 20 ]. These included medical history and ongoing medication use. The documented medical history included: anaemia, diagnosed based on pre-CT haemoglobin levels; diabetes, chronic hypertension, cirrhosis, renal insufficiency (stratified by estimated glomerular filtration rate: 30–60 ml/min/1.73m² or below 30 ml/min/1.73m²), multiple myeloma, heart failure with reduced ejection fraction (< 60%), and gout. Medications with potential nephrotoxicity included metformin, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (cephalosporin, penicillin, aminoglycosides), immunosuppressants (platinum salts, cyclosporin), and amphotericin B. Medications causing hypovolemia or affecting renal vascularization, such as loop diuretics (furosemide), angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, categorized as antihypertensives. 2.2. Outcome Measures The primary outcome was the occurrence of CA-AKI defined as KDIGO (Kidney Disease Improval Global Outcomes) [ 21 ] stage 1 or higher within seven days after contrast-enhanced CT. Patient outcomes, including hospitalization duration, need for renal replacement therapy within 28 days, admission to intensive or high-dependency care units, and in-hospital mortality at 28 days, were also analysed based on hospitalization records 2.3. Ethics The work is conformed to the Declaration of Helsinki. The study was approved by the Scientific and Ethical Committee of Assistance Publique – Hopitaux de Paris (AP-HP) clinical data warehouse (IRB00011591)[ 22 ]. The database was authorized by the National Freedom and Informatics Commission (CNIL Number: 1980120). Assistance Publique – Hopitaux de Paris (AP-HP) clinical data warehouse initiative ensures patients’ information and consent regarding the approved studies through a transparency portal in accordance with European Regulation on data protection and authorization (number 1980120) from the National Freedom and Informatics Commission. The need for informed consent was waived by the Scientific and Ethical Committee of Assistance Publique – Hopitaux de Paris (AP-HP) clinical data warehouse, because of the retrospective nature of the study. 2.4. Statistical Analyses Categorical data are described using ratios (percentages), while continuous data are presented as medians with interquartile ranges (IQR). The characteristics of patients with and without CA-AKI were compared using statistical tests, including the Chi-square test or the Wilcoxon rank-sum test, depending on the case. Univariate logistic regression was used to quantify the association between factors and CA-AKI by estimating odds ratios (OR) with 95% confidence intervals (95% CI). Variables with a p-value < 0.10 in the univariate analysis were included in the multivariate logistic regression model. A generalized linear model was used to obtain both crude and adjusted ORs. Model selection was based on Akaike’s Information Criterion (AIC) to balance the number of retained factors with the precision of the logistic regression. The Hosmer-Lemeshow test was applied to assess the model’s calibration. Data analyses were conducted using R software version 4.0.3 (R Core Team, 2022). The statistical significance threshold was set at 95%, and all tests were two-tailed. 3. Results Between October 2019 and January 2022, 5,079 contrast-enhanced CT requests were reviewed at Beaujon Hospital’s emergency department, with 1,463 examinations included in the study (Fig. 1 ). The incidence of CA-AKI + was 4%. A large majority of CA-AKI + diagnoses were made using serum creatinine levels taken within 48 hours of the CT scan (95.9%), meeting both KDIGO and AKIN (Acute Kidney Injury Network) criteria. The study population was predominantly young, with 63% under 70 years old. CA-AKI + patients were significantly older, with a median age of 69 years, compared to 63 years in the non-CA-AKI group (p = 0.043) (Table 1 ). Table 1 Patients characteristics Available DATA Global (n = 1463) CA-AKI- N = 1398 (96%) CA-AKI+ N = 65 (4%) p-value Demographic Age, median (Q1-Q3) 1463 63 (49–75) 63 (48–74) 69 (56–78) 0.043 Age ≥ 70 yo 1463 544 (37%) 513 (37%) 31 (48%) 0.073 Sexe (men) 1463 804 (55%) 771 (55%) 33 (51%) 0.49 Vital signs Systolic blood pressure (mmHg) 1442 131.0 (115–148) 132 (115–148) 129 (115–151) 0.36 Heart rate (bpm) 1443 97 (83–109) 96.5 (83–110) 97 (79–109) 0.52 Temperature (deg) (Q1-Q3) 1434 36.8 (36.4–37.5) 36.8 (36.4–37.6) 36.6 (36.1–37.1) 0.73 Respiratory rate 1212 18 (16–20) 18 (16–20) 18 (17–22) 0.46 SpO 2 1438 97 (96–100) 97 (96–100) 97 (96–100) 0.36 Glasgow coma scale, median (Q1-Q3) 1402 15 (15–15) 15 (15–15) 15 (15–15) 0.63 Triage Scale, n (%) 1 1450 9 (1%) 8 (1%) 1 (2%) 0.33 2 1450 289 (20%) 281 (20%) 8 (13%) 0.14 3 1450 976 (67%) 932 (67%) 44 (70%) 0.66 4 1450 148 (10%) 139 (10%) 9 (14%) 0.27 5 1450 28 (2%) 27 (2%) 1 (2%) 1.00 Medical History, n (%) HF with reduced LVEF 1463 85 (6%) 80 (6%) 5 (8%) 0.42 Diabetes 1463 317 (22%) 298 (21%) 19 (29%) 0.13 CKD GFR 60 − 30 ml/min/1.73m 2 1463 58 (4%) 52 (4%) 6 (9%) 0.040 CKD GFR < 30 ml/min/1.73m 2 1463 13 (1%) 10 (1%) 3 (5%) 0.017 Anaemia # 1463 698 (48%) 661 (47%) 37 (57%) 0.13 Cirrhosis 1463 90 (6%) 82 (6%) 8 (12%) 0.056 Gout 1463 25 (2%) 23 (2%) 2 (3%) 0.31 Multiple Myeloma 1463 3 (0%) 3 (0,2%) 0 (0%) 1.00 Hypertension 1463 575 (39%) 535 (38%) 40 (62%) 0.0002 Covid-19 1463 173 (12%) 171 (12%) 2 (3%) 0.025 Contrast-enhanced CT ≤ 7 days 1463 143 (10%) 136 (10%) 7 (11%) 0.78 Treatments Antibiotics* 1463 716 (49%) 680 (49%) 36 (55%) 0.29 NSAID £ 1463 281 (19%) 265 (19%) 16 (25%) 0.26 Immunosuppressants $ 1463 59 (4%) 56 (4%) 3 (5%) 0.74 Metformin 1463 152 (10%) 149 (11%) 3 (5%) 0.12 Antihypertensive 1463 428 (29%) 404 (29%) 24 (37%) 0.16 Amphotericin B 1463 15 (1%) 13 (1%) 2 (3%) 0.14 CT indications Infectious disease evaluation 1463 590 (40%) 565 (40%) 25 (38%) 0.75 Oncological assessment 1463 34 (2%) 33 (2%) 1 (2%) 1.00 Vascular assessment 1463 485 (33%) 468 (33%) 17 (26%) 0.22 Trauma assessment 1463 50 (3%) 46 (3%) 4 (6%) 0.28 Suspected Bowel Obstruction 1463 173 (12%) 163 (12%) 10 (15%) 0.36 Postoperative complications assessment 1463 19 (1%) 16 (1%) 3 (5%) 0.05 Pain assessment 1463 95 (6%) 91 (7%) 4 (6%) 1.00 Imaging Cervico-cephalic CT 1463 109 (7%) 105 (8%) 4 (6%) 1.00 Head and thoracic CT 1463 3 (0%) 3 (0%) 0 (0%) 1.00 Thoracic CT 1463 325 (22%) 314 (22%) 11 (17%) 0.29 Abdomino-pelvic CT 1463 820 (56%) 781 (56%) 39 (60%) 0.51 Thoraco-abdomino-pelvic CT 1463 137 (9%) 130 (9%) 7 (11%) 0.69 Musculoskeletal CT 1463 14 (1%) 14 (1%) 0 (0%) 1.00 Spinal CT 1463 9 (1%) 9 (1%) 0 (0%) 1.00 Whole-body CT 1463 39 (3%) 35 (3%) 4 (6%) 0.091 Lower limb CT angiography 1463 7 (0%) 7 (1%) 0 (0%) 1.00 Iodinated contrast media Xenetix® (iobitridol) 1444 363 (25%) 348 (25%) 15 (33%) 0.24 Ioméron® (iomeprol) 1444 780 (54%) 749 (54%) 31 (67%) 0.064 * Cephalosporin, penicillin, aminoglycoside £ Salicylic Acid, ibuprofen, ketoprofen, diclofenac $ Platinum salt, cyclosporine # Hb ≤ 12 g/dL for women, Hb ≤ 13 g/dL for men (Abbreviations: CA-AKI+: Contrast-associated acute kidney injury, CA-AKI-: No contrast-associated acute kidney injury; HF: Heart failure; GFR: Glomerular filtration rate; LVEF: Left ventricular ejection fraction; CKD: Chronic kidney disease; SpO₂: Peripheral oxygen saturation; CT: Computed tomography; min: Minutes) Patients with CA-AKI + had significantly higher rates of chronic kidney disease (CKD). Specifically, 9% had an eGFR between 30–60 mL/min/1.73m², compared to 4% in the non-CA-AKI group (p = 0.040), and 5% had an eGFR below 30 mL/min/1.73m², compared to 1% in the non-CA-AKI group (p = 0.017). Chronic hypertension was also more prevalent in the CA-AKI + group, affecting 62% of patients, compared to 38% in the CA-AKI- group (p = 0.0002). However, a higher rate of COVID-19 infection was observed in the CA-AKI- group, with 12% compared to 3% in the CA-AKI + group (p = 0.025). No significant differences were found in the use of NSAIDs, antibiotics, antihypertensive treatments, amphotericin B, immunosuppressants, or metformin between the two groups. The contrast agents used were primarily IOMERON® (54%) and XENETIX® (25%), with 21% of CT reports having unspecified agents. The increase of serum creatinine levels in the CA-AKI + group was statistically significant (mean increase of 52.9 µmol/L, p < 0.001) (Table 2 ). Table 2 Biological markers based on the presence of CA-AKI, before and after IV contrast-enhanced CT (CT IV+) Pre-TDM Mean (SD) Post-TDM Mean (SD) Δ Mean p-value CA-AKI- (n = 1398) Creatinine (µmol/L) 88.9 (46.1) 76.4 (54.1) -12.5 < 0.001 Haemoglobin (g/dL) 12.5 (2.33) 11.4 (2.06) -1.01 < 0.001 K + (mmol/L) 4.10 (0.595) 3.94 (0.513) -0.167 < 0.001 Na + (mmol/L) 136 (4.35) 137 (3.98) 1.45 < 0.001 Proteinemia (g/L) 72.7 (8.52) 64.7 (9.25) -7.99 < 0.001 Urea (mmol/L) 6.78 (4.39) 6.14 (5.29) -0.638 < 0.001 CA-AKI+ (n = 65) Creatinine (µmol/L) 125 (83.2) 178 (158) 52.9 < 0.001 Haemoglobin (g/dL) 11.6 (2.53) 10.0 (2.09) -1.55 < 0.001 K + (mmol/L) 4.16 (0.723) 4.20 (0.767) 0.0400 0.74 Na + (mmol/L) 137 (4.59) 137 (5.76) 0.800 0.11 Proteinemia (g/L) 70.8 (9.99) 59.5 (10.4) -11.3 < 0.001 Urea (mmol/L) 10.3 (6.45) 13.5 (8.99) 3.19 < 0.001 Abbreviations: CA-AKI+: Contrast-associated acute kidney injury, CA-AKI-: No contrast-associated acute kidney injury; Na + : natremia; K + : Kalemia; CT: Computed tomography; Δ : difference between pre- and post-CT values, SD: standard deviation Additionally, pre-scan serum creatinine was significantly higher in the CA-AKI + group (125 µmol/L vs. 88.9 µmol/L, p < 0.001). Urea levels were significantly higher in the CA-AKI + group before and after the CT, with an increase of 7.36 mmol post-scan compared to a stable level in the CA-AKI- group. Potassium levels showed no significant change in either group at baseline, though potassium decreased by 0.167 mM in the non-CA-AKI group (p < 0.05). Protein levels significantly decreased in both groups, with a greater reduction observed in the CA-AKI + group (11.3 mM vs. 7.99 mM, p < 0.001). Anaemia also worsened more in the CA-AKI + group, with haemoglobin levels dropping by 1.55 g/dL compared to 1.01 g/dL in the non-CA-AKI group. Hospitalisation duration was significantly longer in the CA-AKI + group, with a median of 14 days compared to 8 days in the CA-AKI- group (p = 0.02) (Table 3 ). Table 3 28days in-hospital outcomes after contrast enhanced CT Available DATA Global n = 1463 AKI- N = 1398 (96%) CA-AKI+ N = 65 (4%) P value 28 in-hospital outcomes Median hospital stay (days, Q1 – Q3) 1363 8 (5–14) 8 (5–14) 14 (4–28) < 0.0001 Hospitalisation in ICU 1369 251 (17%) 229 (16%) 22 (34%) 0.0003 RRT 1369 8 (1%) 5 (0.4%) 3 (4.9%) 0.004 Death 1308 78 (5%) 68 (5%) 10 (15%) 0.002 Median waiting time for CT (min, Q1 – Q3) 1386 202 (124–302) 202 (130–302) 202 (130–331) 0.12 Abbreviations: CT: computed tomodensitometry; CA-AKI: contrast-associated acute kidney injury; ICU: intensive care unit; RRT: Renal replacement therapy The need for continuous monitoring unit (USC) care was higher in the CA-AKI + group (34% vs. 16%, p = 0.0003). Renal replacement therapy (RRT) was required in 3 out of 61 hospitalizations in the CA-AKI + group within 28 days, compared to 5 out of 1,398 in the CA-AKI- group (p = 0.004). In-hospital mortality was significantly higher in the CA-AKI + group, with 15% mortality (10 patients) compared to 5% in the CA-AKI- group (68 patients) (p = 0.002). Most deceased CA-AKI + patients were over 70 years old, and many required intensive care. The waiting time before undergoing the CT scan was the same in both groups. Multivariate analysis identified three key risk factors for CA-AKI+ (Table 4 ): delay before CT (unadjusted OR 5.74, adjusted OR 5.46, p = 0.037), severe chronic kidney disease (unadjusted OR 10.43, adjusted OR 5.89, p = 0.033), and medical history of hypertension (unadjusted OR 3.21, adjusted OR 3.36, p < 0.001). Presence of cirrhosis appeared to be a risk factor in the unadjusted analysis (OR 2.46, p = 0.037), but this was not significant after adjustment. Interestingly, metformin use was associated with a reduced risk of CA-AKI+ (adjusted OR 0.26, p = 0.028), suggesting a potential protective effect. Table 4 Crude and adjusted model of risk factors associated to CA-AKI OR crude (CI 95%) OR adjusted (CI 95%) P (Wald's test) P (LR-test) Delay before CT (min) 5.74 (1.4 ; 23.5) 5.46 (1.23 ; 24.21) 0.025 0.037 CKD GFR < 30 ml/min/1.73 m 2 10.43 (2.72 ; 39.92) 5.89 (1.39 ; 24.95) 0.016 0.033 Cirrhose 2.46 (1.01; 5.98) 2.65 (1.06; 6.63) 0.037 0.058 Hypertensin 3.21 (1.71; 6.02) 3.36 (1.76; 6.43) < 0.001 < 0.001 Metformin 0.39 (0.09; 1.61) 0.26 (0.06; 1.12) 0.07 0.028 Ioméron® 1.73 (0.92; 3.24) 1.83 (0.96; 3.48) 0.065 0.059 Abbreviations: OR: Odds ratio; CI confidence interval; CT: computed tomography; CKD: Chronic kidney disease; GFR: Glomerular filtration rat, CA-AKI: contrast-associated acute kidney injury 4. Discussion The incidence of CA-AKI was 4% in a sample of 1,463 patients. Patients with CA-AKI had similar initial severity as those without CA-AKI but were more frequently hospitalised, had longer hospital stays, and faced more severe clinical outcomes, including more intensive care unit (ICU) admissions, higher rates of RRT and more deaths within 28 days. Identified risk factors for CA-AKI included chronic hypertension, chronic kidney disease (CKD) stage ≥ G4, and longer imaging waiting times. 4.1. Primary endpoint The study included patients who had blood tests before and after a contrast-enhanced CT scan, using the KDIGO criteria to diagnose contrast-associated acute kidney injury. This method led to a lower observed incidence of CA-AKI compared to prior studies that used the AKIN criteria. Previous research reported CA-AKI rates ranging from 6.3–8.3%, [ 9 – 11 , 23 ]while this study found lower rates. Factors associated with CA-AKI included older age, advanced chronic kidney disease, chronic hypertension, and metformin use. Despite differences in diagnostic criteria (KDIGO vs. AKIN), the study’s findings were broadly consistent with earlier research. 4.2. Comorbidities 4.2.1. Chronic kidney disease (CKD) CKD, particularly at stage G4-5 (eGFR < 30 ml/min/1.73m²), is recognized as a risk factor for contrast-associated acute kidney injury (CA-AKI) by all major scientific societies[ 24 ]. The current study confirmed this association, aligning with findings from Su et al.[ 11 ], Hinson et al.[ 10 ], and Davenport et al.[ 9 ] reported a significantly increased risk of CA-AKI with eGFR < 30, while Hinson et al.[ 10 ] found a general link between CKD and CA-AKI without a specific eGFR cutoff. Davenport et al.[ 9 ] associated higher CA-AKI risk with elevated creatinine but did not specify an eGFR threshold, a point not supported by the current study. 4.2.2. Hypertension Hypertension was also identified as a significant risk factor for CA-AKI. The prevalence of hypertension in the study population was lower than in American [ 9 , 10 , 25 ], Chinese [ 26 ] and Taiwanese[ 11 ] cohorts. Despite evidence from this and prior studies[ 10 ], as well as a recent meta-analysis[ 12 ], hypertension does not appear to be fully recognized in clinical practice as a contributing risk factor, according to De Laforcade et al. [ 27 ]. Diabetes The natural progression of diabetes is CKD; however, this did not seem to be individually associated with CA-AKI. According to Mehran et al. [ 20 ], diabetes rather amplified the susceptibility of patients with underlying CKD.” The prevalence of diabetic patients in the population studied here was similar to that observed in previous studies (18–23%.) [ 9 – 11 ]. Diabetes is not associated with an increased risk of CA-AKI in any of these studies, supporting the current results. 4.2.3. Heart failure The prevalence rate of heart failure (HF) among US adults is approximately 1.9–2.6% for the overall population and is higher among older patients. The prevalence rate is expected to increase to 8.5% among 65- to 70-year-olds [ 28 ]. In comparison, the French prevalence was 2.6%, rising to 10% in those aged over 70 years [ 29 ]. Regarding definitions used by Su [ 11 ] et al. and Davenport et al.[ 9 ], heart failure is not related to the use of contrast agents. HF, in this study, seems not to be an independent risk factor for CA-AKI 4.3. Nephrotoxic Medications 4.3.1. Antihypertensives : This study found no link between antihypertensive medications and an increased risk of CA-AKI, with similar exposure rates in both affected and unaffected groups. Similarly, a Taiwanese study [ 11 ] observed no significant association between ACE inhibitors, ARBs, or diuretics and CA-AKI, although patients undergoing IV CT were generally less likely to be on these medications. In contrast, Davenport et al. [ 9 ] found a significant association between loop diuretics and CA-AKI risk. However, this was not replicated in the current study, where individual antihypertensive classes were not analysed separately. 4.3.2. Metformin Previous studies have explored the relationship between metformin use, acute kidney injury (AKI), and lactic acidosis. A 2017 UK cohort study [ 30 ] showed that the risk of lactic acidosis increased with the severity of AKI, while a Scottish study [ 31 ] found no significant link between metformin use and AKI. A 2020 French study [ 32 ] suggested that AKI, not contrast agent (CA) injection, leads to metformin accumulation and lactic acidosis. A 2022 meta-analysis [ 33 ] also found no significant association between metformin use and CA-AKI in patients with eGFR ≥ 30 ml/min/1.73m². Consistent with these findings, the current study observed that metformin use was not strongly associated with an increased risk of CA-AKI. 4.4. Secondary Judgment Criteria 4.4.1. Hospitalisation Most patients in the study were hospitalized following their CT scan, with those who developed CA-AKI experiencing significantly longer hospital stays and more frequent ICU admissions. These findings align with Davenport et al. [ 9 ], who reported an average hospital stay of 10.8 days for CA-AKI − patients and 17.6 days for CA-AKI + patients. Although their study lacked a bivariate analysis, they concluded that CA-AKI + was a significant risk factor for ICU admission, based on multivariate analysis (OR 1.01; 95% CI 1.00–1.02; p = 0.01). 4.4.2. Renal replacement therapy (RRT) In the current study, (RRT) was significantly more frequent among CA-AKI + patients, although the number of cases was small. This aligns with Su et al. [ 11 ], who reported a 1.6% dialysis rate and found an increased risk of RRT in patients with reduced kidney function. Specifically, those with an eGFR of 30–44 ml/min/1.73m² had a higher risk of RRT, and this risk increased further for patients with eGFR < 30. However, due to the small sample size, the present study did not analyze the characteristics of patients who required RRT. 4.4.3. Death from All Causes In this study, death from all causes at 28 days was significantly more frequent in the CA-AKI + group. These patients had several confounding risk factors for death in addition to CA injection. This study does not allow for conclusions about the causality of CA in the death or whether it precipitated the death of these patients. Among comparable studies, the "death" criterion was not included in the analyses, making comparison impossible. 4.5. Overcrowding in EDs ED overcrowding, an imbalance between patient volume and timely care[ 34 ], has worsened since COVID-19 and impacts all stages of patient flow—entry, treatment, and discharge. It can lead to delayed exams, limited bed availability, and higher reconsultation rates, indicating inadequate initial care [ 35 – 37 ]. Studies show that ED congestion increases medical errors, delays resuscitation, and raises mortality, particularly when stays exceed four to five hours[ 38 , 39 ]. Prolonged wait times for imaging may contribute to CA-AKI, especially in patients with hypertension or chronic kidney disease, due to factors like dehydration and delayed treatment. Reducing imaging delays could help prevent CA-AKI and improve overall outcomes. 4.6. Study Limitations This retrospective, single-centre study shares common limitations with prior research. It only considered the first imaging exam within seven days and assumed early CA-AKI would be detected through routine follow-up. The study did not find a significantly higher incidence of CA-AKI. Antihypertensive drugs were grouped together, limiting insight into specific agents like loop diuretics, such as furosemide. Nephroprotective measures (e.g., hydration or stopping nephrotoxic medications) and the impact of oral hydration in metformin users were not analysed. Additionally, the study was not designed to assess causality between delayed imaging and subsequent renal failure. Further research is needed to explore these aspects. 5. Conclusion Severe chronic kidney disease (CKD, stage G4 or higher) is the only universally recognized risk factor for (CA-AKI). Routine pre-contrast creatinine testing is recommended in countries with a high prevalence of severe CKD but may be unnecessary for the French population, where severe CKD is less common. Instead, targeted biological testing for high-risk patients—such as those with medical history of hypertension or advanced CKD would be more appropriate. For patients without risk factors, skipping pre-exam testing could help reduce hospital stays and lower associated morbidity and mortality, including CA-AKI. Abbreviations AKIN Acute Kidney Injury Network CA-AKI Contrast-Associated Acute Kidney Injury CI Confidence Interval CKD Chronic Kidney Disease CKD Chronic Kidney Disease CE-CT Contrast Enhanced Computed Tomography ED Emergency Department GFR Glomerular Filtration Rate ICU Intensive Care Unit K+ Kalemia KDIGO Kidney Disease Improval Global Outcomes OR Odds Ratio Na+ Natremia RRT Renal Replacement Therapy SD Standard Deviation Declarations The study was registered at ClinicalTrials.gov on 22 July 2025 (NCT07091656). Ethics approval and consent to participate The work conformed to the Declaration of Helsinki. The informed consent was waived by the institutional review board called Assistance Publique des Hôpitaux de Paris Clinical Data Warehouse (AP-HP CDW) Scientific and Ethics Committee (Conseil Scientifique et Ethique; IRB number : 00011591). Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interest. Funding The authors received no funding from an external source. Authors' contributions EL : Data curation; Formal analysis; Investigation; Methodology; Visualization;. Pradeebane VA: Formal analysis; Supervision; Validation; Visualization; Writing - review & editing. VV: Methodology; Supervision; Validation; Writing - review & editing. Prabakar VA: Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Supervision; Validation; Visualization; Roles/Writing - original draft; and Writing - review & editing. Acknowledgements Not applicable References Dillenseger Jean-Philippe. Guide des technologies de l’imagerie médicale et de la radiothérapie: quand la théorie éclaire la pratique / Jean-Philippe Dillenseger, Elisabeth Moerschel, Claudine Zorn ; illustrations, Jean-Philippe Dillenseger préface à la 2e édition Jean-Louis Dietemann. 2e édition. Issy-les-Moulineaux: Elsevier Masson; 2016. Beer E. Uroselectan-Intravenous urography. Ann Surg. 1930;92:761–5. Hartman GW. Uroselectan - Reactions accompanying its practical application: report of cases. Calif West Med. 1930;33:867–72. Moreau J-F, Droz D, Noel L-H. Nephrotoxicity of metrizamide in man. The Lancet. 1978;311:1201. Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. Kidney Int. 1995;47:254–61. Rudnick et al. - 1995 - Nephrotoxicity of ionic and nonionic contrast medi.pdf. Jo S, Jeong T, Jin YH, Lee JB, Yoon J, Park B. ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study. Am J Emerg Med. 2015;33:1725–31. Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, et al. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthc Basel Switz. 2022;10:1625. Davenport MS, Khalatbari S, Dillman JR, Cohan RH, Caoili EM, Ellis JH. Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material. Radiology. 2013;267:94–105. Hinson JS, Ehmann MR, Fine DM, Fishman EK, Toerper MF, Rothman RE, et al. Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Ann Emerg Med. 2017;69:577-586.e4. Su T-H, Hsieh C-H, Chan Y-L, Wong Y-C, Kuo C-F, Li C-H, et al. Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department–based Study. Radiology. 2021;301:571–81. Obed M, Gabriel MM, Dumann E, Vollmer Barbosa C, Weißenborn K, Schmidt BMW. Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score–matched cohort studies. Eur Radiol. 2022;32:8432–42. Ehmann MR, Mitchell J, Levin S, Smith A, Menez S, Hinson JS, et al. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Intensive Care Med. 2023;49:205–15. Berglund F, Eilertz E, Nimmersjö F, Wolf A, Nordlander C, Palm F, et al. Acute and long-term renal effects after iodine contrast media–enhanced computerised tomography in the critically ill—a retrospective bi-centre cohort study. Eur Radiol. 2024;34:1736–45. Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, Janssen MM, Vermeeren MA, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet Lond Engl. 2017;389:1312–22. Locham S, Rodriguez A, Balceniuk MD, Mix D, Newhall K, Doyle A, et al. Contrast-Associated Acute Kidney Injury in High-Risk Patients Undergoing Peripheral Vascular Interventions. Vasc Endovascular Surg. 2023;57:583–91. Yan P, Duan S-B, Luo X-Q, Zhang N-Y, Deng Y-H. Effects of intravenous hydration in preventing post-contrast acute kidney injury in patients with eGFR < 30 mL/min/1.73 m2. Eur Radiol. 2023;33:9434–43. de Laforcade L, Bobot M, Bellin M-F, Clément O, Grangé S, Grenier N, et al. Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging. 2021;102:131–9. CIRTACI, SFNDT. Fiche de recommandation pour la pratique clinique: rein et produit de contraste. Parue en 2020. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med [Internet]. 2019 [cited 2021 Dec 14]; Available from: https://www-nejm-org.ezproxy.u-paris.fr/doi/10.1056/NEJMra1805256 Kidney Disease Improving Global Outcomes, (KDIGO). Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1. Daniel C, Paris N, Pierre O, Griffon N, Breant S, phane, et al. AP-HP Health Data Space (AHDS) to the Test of the Covid-19 Pandemic. Chall Trust AI Added-Value Health [Internet]. IOS Press; 2022 [cited 2025 Jun 6]. p. 28–32. Available from: https://ebooks.iospress.nl/doi/10.3233/SHTI220390 Ferrer Puchol MD, Montesinos García P, Forment Navarro M, Sanz Rodrigo E, Blanco Pérez E, Taberner López E. The administration of contrast media: is there a risk of acute kidney injury? Radiologia. 2019;61:306–14. ESUR GUIDELINES ON CONTRAST AGENTS | esur.org [Internet]. [cited 2023 Nov 21]. Available from: https://www.esur.org/esur-guidelines-on-contrast-agents/ Centers for Disease Control and Prevention. Hypertension Prevalence in the U.S. | Million Hearts® [Internet]. Cent. Dis. Control Prev. 2023 [cited 2023 Nov 21]. Available from: https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet Lond Engl. 2017;390:2549–58. de Laforcade L, Bobot M, Bellin M-F, Clément O, Grangé S, Grenier N, et al. Recommandations ESUR sur l’utilisation des produits de contraste : enquête de pratique, revue et commentaire par le CJN, le FIRN et la SFNDT. Néphrologie Thérapeutique. 2021;17:80–91. Bozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, et al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail. 2023;29:1412–51. Gabet A, Blacher J, Pousset F, Grave C, Lailler G, Tuppin P, et al. Epidemiology of heart failure in France. Arch Cardiovasc Dis. 2024;117:705–14. Connelly PJ, Lonergan M, Soto-Pedre E, Donnelly L, Zhou K, Pearson ER. Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: A GoDarts study. Diabetes Obes Metab. 2017;19:1579–86. Bell S, Farran B, McGurnaghan S, McCrimmon RJ, Leese GP, Petrie JR, et al. Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. BMC Nephrol. 2017;18:163. Corchia A, Wynckel A, Journet J, Moussi Frances J, Skandrani N, Lautrette A, et al. Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study. Clin Toxicol Phila Pa. 2020;58:375–82. Qiao H, Li Y, Xu B, Lu Z, Zhang J, Meng D, et al. Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis. Cardiology. 2022;147:469–78. American College of Emergency Physicians (ACEP). Crowding. Policy statement. Ann Emerg Med. 2013;61:726–7. Ouyang H, Wang J, Sun Z, Lang E. The impact of emergency department crowding on admission decisions and patient outcomes. Am J Emerg Med. 2022;51:163–8. Kwok E, Mackenzie T. A Novel Emergency Department Surge Protocol: Implementation of a Targeted Response Plan. J Clin Outcomes Manag JCOM. 2015;22:495–503. Kenny JF, Chang BC, Hemmert KC. Factors Affecting Emergency Department Crowding. Emerg Med Clin North Am. 2020;38:573–87. Epstein SK, Huckins DS, Liu SW, Pallin DJ, Sullivan AF, Lipton RI, et al. Emergency department crowding and risk of preventable medical errors. Intern Emerg Med. 2012;7:173–80. Jones S, Moulton C, Swift S, Molyneux P, Black S, Mason N, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J EMJ. 2022;39:168–73. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7357786","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505986979,"identity":"93639659-7f95-4f65-bf1c-a4b193409200","order_by":0,"name":"Elodie Lecomte","email":"","orcid":"","institution":"Hospital Beaujon, AP-HP. Nord","correspondingAuthor":false,"prefix":"","firstName":"Elodie","middleName":"","lastName":"Lecomte","suffix":""},{"id":505986980,"identity":"74b7ad7b-e63b-4f7c-91b0-0dabfc4015ca","order_by":1,"name":"Pradeebane Vaittinada Ayar","email":"","orcid":"","institution":"CNRS/CEA/UVSQ, UMR8212, Université Paris-Saclay","correspondingAuthor":false,"prefix":"","firstName":"Pradeebane","middleName":"Vaittinada","lastName":"Ayar","suffix":""},{"id":505986981,"identity":"f278754f-ea44-4489-a114-6d434cb777b2","order_by":2,"name":"Valérie Vilgrain","email":"","orcid":"","institution":"Hospital Beaujon, AP-HP. Nord","correspondingAuthor":false,"prefix":"","firstName":"Valérie","middleName":"","lastName":"Vilgrain","suffix":""},{"id":505986982,"identity":"233f131e-5ad7-481d-b903-651423e8a07c","order_by":3,"name":"Prabakar Vaittinada Ayar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYJCCAwwMEkAqgfEBkOThI0rLgQSwFmYDkBY24qxJAJEJbCCNDAS1mEskPzz88YdFHn978rPKrzl2MmwMzA8f3cCjxXJGmgHIYcUSZ56Z3Zbdlgx0GJuxcQ4eLQZnDoC1JDbcSDC7LbmNGaiFh00av5bjH8Ba5t9I/1Ysua2eCC3HeyC2bLiRY8b4cdthwlos23sKDpxJk0jceOZNsTTjtuM8bMwE/GLOzL75Q4VNXeK84+kbP/7cVm3Pz9788DFehyFzmHnAJB7lGFoYfxBQPQpGwSgYBSMTAADxik4MkpBp8wAAAABJRU5ErkJggg==","orcid":"","institution":"Hospital Beaujon, AP-HP. Nord","correspondingAuthor":true,"prefix":"","firstName":"Prabakar","middleName":"Vaittinada","lastName":"Ayar","suffix":""}],"badges":[],"createdAt":"2025-08-12 16:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7357786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7357786/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12245-025-01058-0","type":"published","date":"2025-12-29T15:58:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90304622,"identity":"70a69c2d-3c66-4a57-9a88-662884d8abb6","added_by":"auto","created_at":"2025-09-01 09:18:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":816549,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart\u003c/p\u003e\n\u003cp\u003e(CT: computed tomodensitometry; CA-AKI: contrast-associated acute kidney injury; ICU: intensive care unit; RRT: Renal replacement therapy)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7357786/v1/dd93af98613bd7014f341a38.jpeg"},{"id":99545397,"identity":"3466c40a-4aca-4767-8a54-7805f00a1827","added_by":"auto","created_at":"2026-01-05 16:07:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1950106,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7357786/v1/14c9b7c1-d46d-4bf2-b3d8-f62f839511b7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Incidence and risk factors of contrast-associated acute kidney injury in patients hospitalised after contrast-enhanced computed tomography in the Emergency Department","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe use of iodinated contrast agents dates back to 1901, initially with lipid-soluble formulations and later with water-soluble agents for vascular injection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Early studies raised concerns about their potential nephrotoxicity, leading to caution in their use [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite advancements in contrast agents, many studies have attempted to elucidate this tubular toxicity. However, due to limitations in sample size, statistical power, ethical considerations, and pathophysiological arguments (based on animal or post-mortem studies) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the belief in contrast-induced acute kidney injury (CI-AKI) has persisted, resulting in routine pre-imaging kidney function tests and prolonged stays in emergency departments.\u003c/p\u003e\u003cp\u003eResearch has shown that overcrowding in emergency departments increases patient morbidity and mortality, delays critical treatments, and complicates overall emergency care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Reducing unnecessary tests, such as routine pre-imaging kidney function assessments, could help shorten hospital stays and improve efficiency.\u003c/p\u003e\u003cp\u003eSeveral large-scale studies conducted between 2013 and 2023 have challenged the notion that intravenous (IV) iodinated contrast significantly increases the risk of acute kidney injury in acute settings. Studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] found no significant link between IV iodinated contrast use and kidney injury. In 2021, in Taiwan, a large retrospective cohort study in ED observed a mild short-term risk but no long-term impact [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In 2022, a meta-analysis concluded that withholding contrast-enhanced imaging due to nephrotoxicity concerns is not justified for most patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Recent studies in intensive care unit confirmed that contrast-enhanced imaging did not worsen kidney function, even in patients with pre-existing AKI [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and did not determine any increased risk of AKI or long-term decline in renal function when iodine contrast media is used [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Preventive hydration did not change the risk of CI-AKI [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], also in patients with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e intravenous hydration before and after intravenous administration of iodine contrast media is not associated with lower risks in CI-AKI, chronic dialysis at discharge, and in-hospital mortality [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Updated guidelines have also reflected this understanding shift. The European Society of Urogenital Radiology (ESUR) in 2018 redefined contrast-induced nephropathy while maintaining cautious recommendations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In 2020, the CIRTACI (Comit\u0026eacute; interdisciplinaire de recherche et de travail sur les agents de contraste en imagerie) committee renamed CI-AKI as \"contrast-associated acute kidney injury\" (CA-AKI), emphasizing the lack of proven causality [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The main risk factors identified remain severe kidney disease (eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30 mL/min/1.73 m2 ) and dehydration, rather than the contrast agents themselves.\u003c/p\u003e\u003cp\u003eThis study aimed to assess the incidence and the factors associated to CA-AKI in hospitalised patient after ED visit. The objective is to provide further evidence supporting the safety of contrast-enhanced computed tomography (CE-CT), which could help eliminate unnecessary pre-imaging tests, reduce hospital overcrowding, and improve patient management in emergency settings.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design\u003c/h2\u003e\u003cp\u003eThis was a retrospective cohort observational study in the ED of the Beaujon University Hospital between October 31st 2019 to January 24th 2022.\u003c/p\u003e\u003cp\u003ePatients over 16 years old who presented to the emergency department and underwent an intravenous contrast-enhanced CT were eligible. To be included, patients were required to have at least two creatinine measurements: one taken within 24 hours before CT and a second measurement taken between 48 hours to the seventh day following the initial test. The CT examination had to be performed at Beaujon Hospital with the injection of iodinated contrast agents such as IOMERON\u0026reg; (iomeprol) or XENETIX\u0026reg; (iobitridol).\u003c/p\u003e\u003cp\u003ePatients were excluded from the study if they did not have two creatinine measurements meeting the specified criteria. If multiple contrast-enhanced CT examinations were performed within a seven-day period for the same patient, only the first examination was included in the study, while subsequent scans were excluded. Repeated CE-CT within 7 days consequences were not evaluated in this study because there were few patients and it was not the purpose of the study.\u003c/p\u003e\u003cp\u003eThe collected imaging data were extracted from the PACS (Carestream Health, Inc., 2022. CAT 600 0500 02/22). Laboratory and consultation data were extracted from the Orbis\u0026reg; medical data processing system (Agfa Healthcare). The collected data included demographic, qualitative, and quantitative information. An additional analysis was conducted to assess patient outcomes after their emergency department visit. Data were accessed for research purposes from January 24th 2022 to December 31st 2022.\u003c/p\u003e\u003cp\u003eThe demographic data collected included age and sex. The quantitative data included vital signs recorded by the emergency department triage nurses. The documented parameters included the triage score, systolic blood pressure, heart rate, temperature, respiratory rate, oxygen saturation, Glasgow Coma Scale score. Biological parameters included serum potassium, urea levels, serum sodium, protein levels, haemoglobin levels. The qualitative data were factors previously identified as risk factors for CA-AKI in prior studies[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These included medical history and ongoing medication use. The documented medical history included: anaemia, diagnosed based on pre-CT haemoglobin levels; diabetes, chronic hypertension, cirrhosis, renal insufficiency (stratified by estimated glomerular filtration rate: 30\u0026ndash;60 ml/min/1.73m\u0026sup2; or below 30 ml/min/1.73m\u0026sup2;), multiple myeloma, heart failure with reduced ejection fraction (\u0026lt;\u0026thinsp;60%), and gout. Medications with potential nephrotoxicity included metformin, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (cephalosporin, penicillin, aminoglycosides), immunosuppressants (platinum salts, cyclosporin), and amphotericin B. Medications causing hypovolemia or affecting renal vascularization, such as loop diuretics (furosemide), angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, categorized as antihypertensives.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Outcome Measures\u003c/h2\u003e\u003cp\u003eThe primary outcome was the occurrence of CA-AKI defined as KDIGO (Kidney Disease Improval Global Outcomes) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] stage 1 or higher within seven days after contrast-enhanced CT.\u003c/p\u003e\u003cp\u003ePatient outcomes, including hospitalization duration, need for renal replacement therapy within 28 days, admission to intensive or high-dependency care units, and in-hospital mortality at 28 days, were also analysed based on hospitalization records\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Ethics\u003c/h2\u003e\u003cp\u003eThe work is conformed to the Declaration of Helsinki. The study was approved by the Scientific and Ethical Committee of Assistance Publique \u0026ndash; Hopitaux de Paris (AP-HP) clinical data warehouse (IRB00011591)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The database was authorized by the National Freedom and Informatics Commission (CNIL Number: 1980120). Assistance Publique \u0026ndash; Hopitaux de Paris (AP-HP) clinical data warehouse initiative ensures patients\u0026rsquo; information and consent regarding the approved studies through a transparency portal in accordance with European Regulation on data protection and authorization (number 1980120) from the National Freedom and Informatics Commission. The need for informed consent was waived by the Scientific and Ethical Committee of Assistance Publique \u0026ndash; Hopitaux de Paris (AP-HP) clinical data warehouse, because of the retrospective nature of the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Statistical Analyses\u003c/h2\u003e\u003cp\u003eCategorical data are described using ratios (percentages), while continuous data are presented as medians with interquartile ranges (IQR). The characteristics of patients with and without CA-AKI were compared using statistical tests, including the Chi-square test or the Wilcoxon rank-sum test, depending on the case. Univariate logistic regression was used to quantify the association between factors and CA-AKI by estimating odds ratios (OR) with 95% confidence intervals (95% CI). Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in the univariate analysis were included in the multivariate logistic regression model. A generalized linear model was used to obtain both crude and adjusted ORs. Model selection was based on Akaike\u0026rsquo;s Information Criterion (AIC) to balance the number of retained factors with the precision of the logistic regression. The Hosmer-Lemeshow test was applied to assess the model\u0026rsquo;s calibration. Data analyses were conducted using R software version 4.0.3 (R Core Team, 2022). The statistical significance threshold was set at 95%, and all tests were two-tailed.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eBetween October 2019 and January 2022, 5,079 contrast-enhanced CT requests were reviewed at Beaujon Hospital\u0026rsquo;s emergency department, with 1,463 examinations included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe incidence of CA-AKI\u0026thinsp;+\u0026thinsp;was 4%. A large majority of CA-AKI\u0026thinsp;+\u0026thinsp;diagnoses were made using serum creatinine levels taken within 48 hours of the CT scan (95.9%), meeting both KDIGO and AKIN (Acute Kidney Injury Network) criteria. The study population was predominantly young, with 63% under 70 years old. CA-AKI\u0026thinsp;+\u0026thinsp;patients were significantly older, with a median age of 69 years, compared to 63 years in the non-CA-AKI group (p\u0026thinsp;=\u0026thinsp;0.043) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAvailable DATA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGlobal (n\u0026thinsp;=\u0026thinsp;1463)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCA-AKI-\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1398 (96%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCA-AKI+\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;65 (4%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, median (Q1-Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e63 (49\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63 (48\u0026ndash;74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69 (56\u0026ndash;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.043\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;70 yo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e544 (37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e513 (37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31 (48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexe (men)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e804 (55%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e771 (55%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33 (51%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVital signs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystolic blood pressure (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e131.0 (115\u0026ndash;148)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e132 (115\u0026ndash;148)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e129 (115\u0026ndash;151)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart rate (bpm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e97 (83\u0026ndash;109)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e96.5 (83\u0026ndash;110)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97 (79\u0026ndash;109)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemperature (deg) (Q1-Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e36.8 (36.4\u0026ndash;37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36.8 (36.4\u0026ndash;37.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36.6 (36.1\u0026ndash;37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e18 (16\u0026ndash;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18 (16\u0026ndash;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 (17\u0026ndash;22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1438\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e97 (96\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e97 (96\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97 (96\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlasgow coma scale, median (Q1-Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriage Scale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e289 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e281 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e976 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e932 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e148 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e139 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e28 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMedical History, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHF with reduced LVEF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e85 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e317 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e298 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD GFR 60\u0026thinsp;\u0026minus;\u0026thinsp;30 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e58 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD GFR\u0026thinsp;\u0026lt;\u0026thinsp;30 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnaemia\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e698 (48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e661 (47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37 (57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCirrhosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e90 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e25 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple Myeloma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0,2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e575 (39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e535 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40 (62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.0002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCovid-19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e173 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e171 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContrast-enhanced CT\u0026thinsp;\u0026le;\u0026thinsp;7 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e143 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e136 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntibiotics*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e716 (49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e680 (49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36 (55%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSAID\u003csup\u003e\u0026pound;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e281 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e265 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmunosuppressants\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e59 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e152 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e149 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e428 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e404 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 (37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmphotericin B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e15 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT indications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfectious disease evaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e590 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e565 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncological assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e34 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e485 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e468 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17 (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrauma assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e50 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuspected Bowel Obstruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e173 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e163 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative complications assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e19 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e95 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e91 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImaging\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCervico-cephalic CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e109 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e105 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead and thoracic CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThoracic CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e325 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e314 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdomino-pelvic CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e820 (56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e781 (56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39 (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThoraco-abdomino-pelvic CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e137 (9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e130 (9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMusculoskeletal CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e14 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpinal CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole-body CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e39 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35 (3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower limb CT angiography\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIodinated contrast media\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eXenetix\u0026reg; (iobitridol)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e363 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e348 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIom\u0026eacute;ron\u0026reg; (iomeprol)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e780 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e749 (54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e* Cephalosporin, penicillin, aminoglycoside\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026pound;\u003c/sup\u003e Salicylic Acid, ibuprofen, ketoprofen, diclofenac\u003c/p\u003e\u003cp\u003e\u003csup\u003e$\u003c/sup\u003e Platinum salt, cyclosporine\u003c/p\u003e\u003cp\u003e\u003csup\u003e#\u003c/sup\u003e Hb\u0026thinsp;\u0026le;\u0026thinsp;12 g/dL for women, Hb\u0026thinsp;\u0026le;\u0026thinsp;13 g/dL for men\u003c/p\u003e\u003cp\u003e(Abbreviations: CA-AKI+: Contrast-associated acute kidney injury, CA-AKI-: No contrast-associated acute kidney injury; HF: Heart failure; GFR: Glomerular filtration rate; LVEF: Left ventricular ejection fraction; CKD: Chronic kidney disease; SpO₂: Peripheral oxygen saturation; CT: Computed tomography; min: Minutes)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePatients with CA-AKI\u0026thinsp;+\u0026thinsp;had significantly higher rates of chronic kidney disease (CKD). Specifically, 9% had an eGFR between 30\u0026ndash;60 mL/min/1.73m\u0026sup2;, compared to 4% in the non-CA-AKI group (p\u0026thinsp;=\u0026thinsp;0.040), and 5% had an eGFR below 30 mL/min/1.73m\u0026sup2;, compared to 1% in the non-CA-AKI group (p\u0026thinsp;=\u0026thinsp;0.017). Chronic hypertension was also more prevalent in the CA-AKI\u0026thinsp;+\u0026thinsp;group, affecting 62% of patients, compared to 38% in the CA-AKI- group (p\u0026thinsp;=\u0026thinsp;0.0002). However, a higher rate of COVID-19 infection was observed in the CA-AKI- group, with 12% compared to 3% in the CA-AKI\u0026thinsp;+\u0026thinsp;group (p\u0026thinsp;=\u0026thinsp;0.025). No significant differences were found in the use of NSAIDs, antibiotics, antihypertensive treatments, amphotericin B, immunosuppressants, or metformin between the two groups. The contrast agents used were primarily IOMERON\u0026reg; (54%) and XENETIX\u0026reg; (25%), with 21% of CT reports having unspecified agents.\u003c/p\u003e\u003cp\u003eThe increase of serum creatinine levels in the CA-AKI\u0026thinsp;+\u0026thinsp;group was statistically significant (mean increase of 52.9 \u0026micro;mol/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBiological markers based on the presence of CA-AKI, before and after IV contrast-enhanced CT (CT IV+)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre-TDM\u003c/p\u003e\u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePost-TDM\u003c/p\u003e\u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eΔ\u0026nbsp;Mean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCA-AKI- (n\u0026thinsp;=\u0026thinsp;1398)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e88.9\u0026nbsp;(46.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e76.4\u0026nbsp;(54.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHaemoglobin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12.5\u0026nbsp;(2.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11.4\u0026nbsp;(2.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK\u003csup\u003e+\u003c/sup\u003e (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.10\u0026nbsp;(0.595)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3.94\u0026nbsp;(0.513)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNa\u003csup\u003e+\u003c/sup\u003e (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e136\u0026nbsp;(4.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e137\u0026nbsp;(3.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProteinemia (g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e72.7\u0026nbsp;(8.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e64.7\u0026nbsp;(9.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-7.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e6.78\u0026nbsp;(4.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6.14\u0026nbsp;(5.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-0.638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eCA-AKI+ (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e125\u0026nbsp;(83.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e178\u0026nbsp;(158)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e52.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHaemoglobin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e11.6\u0026nbsp;(2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e10.0\u0026nbsp;(2.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK\u003csup\u003e+\u003c/sup\u003e (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.16\u0026nbsp;(0.723)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4.20\u0026nbsp;(0.767)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.0400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNa\u003csup\u003e+\u003c/sup\u003e(mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e137\u0026nbsp;(4.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e137\u0026nbsp;(5.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProteinemia (g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e70.8\u0026nbsp;(9.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e59.5\u0026nbsp;(10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e-11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e10.3\u0026nbsp;(6.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13.5\u0026nbsp;(8.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: CA-AKI+: Contrast-associated acute kidney injury, CA-AKI-: No contrast-associated acute kidney injury; Na\u003csup\u003e+\u003c/sup\u003e: natremia; K\u003csup\u003e+\u003c/sup\u003e: Kalemia; CT: Computed tomography; Δ\u0026nbsp;: difference between pre- and post-CT values, SD: standard deviation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, pre-scan serum creatinine was significantly higher in the CA-AKI\u0026thinsp;+\u0026thinsp;group (125 \u0026micro;mol/L vs. 88.9 \u0026micro;mol/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Urea levels were significantly higher in the CA-AKI\u0026thinsp;+\u0026thinsp;group before and after the CT, with an increase of 7.36 mmol post-scan compared to a stable level in the CA-AKI- group. Potassium levels showed no significant change in either group at baseline, though potassium decreased by 0.167 mM in the non-CA-AKI group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Protein levels significantly decreased in both groups, with a greater reduction observed in the CA-AKI\u0026thinsp;+\u0026thinsp;group (11.3 mM vs. 7.99 mM, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Anaemia also worsened more in the CA-AKI\u0026thinsp;+\u0026thinsp;group, with haemoglobin levels dropping by 1.55 g/dL compared to 1.01 g/dL in the non-CA-AKI group.\u003c/p\u003e\u003cp\u003eHospitalisation duration was significantly longer in the CA-AKI\u0026thinsp;+\u0026thinsp;group, with a median of 14 days compared to 8 days in the CA-AKI- group (p\u0026thinsp;=\u0026thinsp;0.02) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e28days in-hospital outcomes after contrast enhanced CT\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvailable DATA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGlobal n\u0026thinsp;=\u0026thinsp;1463\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAKI-\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1398 (96%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCA-AKI+\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;65 (4%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e28 in-hospital outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian hospital stay\u003c/p\u003e\u003cp\u003e(days, Q1 \u0026ndash; Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (5\u0026ndash;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (5\u0026ndash;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (4\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospitalisation in ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e251 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e229 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.0003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRRT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (0.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian waiting time for CT (min, Q1 \u0026ndash; Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202\u003c/p\u003e\u003cp\u003e(124\u0026ndash;302)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e202\u003c/p\u003e\u003cp\u003e(130\u0026ndash;302)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e202\u003c/p\u003e\u003cp\u003e(130\u0026ndash;331)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: CT: computed tomodensitometry; CA-AKI: contrast-associated acute kidney injury; ICU: intensive care unit; RRT: Renal replacement therapy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe need for continuous monitoring unit (USC) care was higher in the CA-AKI\u0026thinsp;+\u0026thinsp;group (34% vs. 16%, p\u0026thinsp;=\u0026thinsp;0.0003). Renal replacement therapy (RRT) was required in 3 out of 61 hospitalizations in the CA-AKI\u0026thinsp;+\u0026thinsp;group within 28 days, compared to 5 out of 1,398 in the CA-AKI- group (p\u0026thinsp;=\u0026thinsp;0.004). In-hospital mortality was significantly higher in the CA-AKI\u0026thinsp;+\u0026thinsp;group, with 15% mortality (10 patients) compared to 5% in the CA-AKI- group (68 patients) (p\u0026thinsp;=\u0026thinsp;0.002). Most deceased CA-AKI\u0026thinsp;+\u0026thinsp;patients were over 70 years old, and many required intensive care.\u003c/p\u003e\u003cp\u003eThe waiting time before undergoing the CT scan was the same in both groups.\u003c/p\u003e\u003cp\u003eMultivariate analysis identified three key risk factors for CA-AKI+ (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e): delay before CT (unadjusted OR 5.74, adjusted OR 5.46, p\u0026thinsp;=\u0026thinsp;0.037), severe chronic kidney disease (unadjusted OR 10.43, adjusted OR 5.89, p\u0026thinsp;=\u0026thinsp;0.033), and medical history of hypertension (unadjusted OR 3.21, adjusted OR 3.36, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Presence of cirrhosis appeared to be a risk factor in the unadjusted analysis (OR 2.46, p\u0026thinsp;=\u0026thinsp;0.037), but this was not significant after adjustment. Interestingly, metformin use was associated with a reduced risk of CA-AKI+ (adjusted OR 0.26, p\u0026thinsp;=\u0026thinsp;0.028), suggesting a potential protective effect.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCrude and adjusted model of risk factors associated to CA-AKI\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR crude (CI 95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR adjusted (CI 95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP (Wald's test)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP (LR-test)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelay before CT (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.74 (1.4\u0026nbsp;; 23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.46 (1.23\u0026nbsp;; 24.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD GFR\u0026thinsp;\u0026lt;\u0026thinsp;30 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.43 (2.72\u0026nbsp;; 39.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.89 (1.39\u0026nbsp;; 24.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCirrhose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.46 (1.01; 5.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.65 (1.06; 6.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.21 (1.71; 6.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.36 (1.76; 6.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.39 (0.09; 1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.26 (0.06; 1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIom\u0026eacute;ron\u0026reg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.73 (0.92; 3.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.83 (0.96; 3.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: OR: Odds ratio; CI confidence interval; CT: computed tomography; CKD: Chronic kidney disease; GFR: Glomerular filtration rat, CA-AKI: contrast-associated acute kidney injury\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe incidence of CA-AKI was 4% in a sample of 1,463 patients. Patients with CA-AKI had similar initial severity as those without CA-AKI but were more frequently hospitalised, had longer hospital stays, and faced more severe clinical outcomes, including more intensive care unit (ICU) admissions, higher rates of RRT and more deaths within 28 days. Identified risk factors for CA-AKI included chronic hypertension, chronic kidney disease (CKD) stage\u0026thinsp;\u0026ge;\u0026thinsp;G4, and longer imaging waiting times.\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Primary endpoint\u003c/h2\u003e\u003cp\u003eThe study included patients who had blood tests before and after a contrast-enhanced CT scan, using the KDIGO criteria to diagnose contrast-associated acute kidney injury. This method led to a lower observed incidence of CA-AKI compared to prior studies that used the AKIN criteria. Previous research reported CA-AKI rates ranging from 6.3\u0026ndash;8.3%, [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]while this study found lower rates. Factors associated with CA-AKI included older age, advanced chronic kidney disease, chronic hypertension, and metformin use. Despite differences in diagnostic criteria (KDIGO vs. AKIN), the study\u0026rsquo;s findings were broadly consistent with earlier research.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Comorbidities\u003c/h2\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1. Chronic kidney disease (CKD)\u003c/h2\u003e\u003cp\u003eCKD, particularly at stage G4-5 (eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30 ml/min/1.73m\u0026sup2;), is recognized as a risk factor for contrast-associated acute kidney injury (CA-AKI) by all major scientific societies[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The current study confirmed this association, aligning with findings from Su et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Hinson et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and Davenport et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported a significantly increased risk of CA-AKI with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30, while Hinson et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] found a general link between CKD and CA-AKI without a specific eGFR cutoff. Davenport et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] associated higher CA-AKI risk with elevated creatinine but did not specify an eGFR threshold, a point not supported by the current study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2. Hypertension\u003c/h2\u003e\u003cp\u003eHypertension was also identified as a significant risk factor for CA-AKI. The prevalence of hypertension in the study population was lower than in American [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Chinese [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and Taiwanese[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] cohorts. Despite evidence from this and prior studies[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], as well as a recent meta-analysis[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], hypertension does not appear to be fully recognized in clinical practice as a contributing risk factor, according to De Laforcade et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003cp\u003eThe natural progression of diabetes is CKD; however, this did not seem to be individually associated with CA-AKI. According to Mehran et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], diabetes rather amplified the susceptibility of patients with underlying CKD.\u0026rdquo; The prevalence of diabetic patients in the population studied here was similar to that observed in previous studies (18\u0026ndash;23%.) [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Diabetes is not associated with an increased risk of CA-AKI in any of these studies, supporting the current results.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e4.2.3. Heart failure\u003c/h2\u003e\u003cp\u003eThe prevalence rate of heart failure (HF) among US adults is approximately 1.9\u0026ndash;2.6% for the overall population and is higher among older patients. The prevalence rate is expected to increase to 8.5% among 65- to 70-year-olds [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In comparison, the French prevalence was 2.6%, rising to 10% in those aged over 70 years [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Regarding definitions used by Su [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] et al. and Davenport et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], heart failure is not related to the use of contrast agents. HF, in this study, seems not to be an independent risk factor for CA-AKI\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Nephrotoxic Medications\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e4.3.1. \u003cb\u003eAntihypertensives\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eThis study found no link between antihypertensive medications and an increased risk of CA-AKI, with similar exposure rates in both affected and unaffected groups. Similarly, a Taiwanese study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] observed no significant association between ACE inhibitors, ARBs, or diuretics and CA-AKI, although patients undergoing IV CT were generally less likely to be on these medications. In contrast, Davenport et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] found a significant association between loop diuretics and CA-AKI risk. However, this was not replicated in the current study, where individual antihypertensive classes were not analysed separately.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e4.3.2. Metformin\u003c/h2\u003e\u003cp\u003ePrevious studies have explored the relationship between metformin use, acute kidney injury (AKI), and lactic acidosis. A 2017 UK cohort study [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] showed that the risk of lactic acidosis increased with the severity of AKI, while a Scottish study [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] found no significant link between metformin use and AKI. A 2020 French study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] suggested that AKI, not contrast agent (CA) injection, leads to metformin accumulation and lactic acidosis. A 2022 meta-analysis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] also found no significant association between metformin use and CA-AKI in patients with eGFR\u0026thinsp;\u0026ge;\u0026thinsp;30 ml/min/1.73m\u0026sup2;. Consistent with these findings, the current study observed that metformin use was not strongly associated with an increased risk of CA-AKI.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.4. \u003cb\u003eSecondary Judgment Criteria\u003c/b\u003e\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e4.4.1. Hospitalisation\u003c/h2\u003e\u003cp\u003eMost patients in the study were hospitalized following their CT scan, with those who developed CA-AKI experiencing significantly longer hospital stays and more frequent ICU admissions. These findings align with Davenport et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], who reported an average hospital stay of 10.8 days for CA-AKI\u0026thinsp;\u0026minus;\u0026thinsp;patients and 17.6 days for CA-AKI\u0026thinsp;+\u0026thinsp;patients. Although their study lacked a bivariate analysis, they concluded that CA-AKI\u0026thinsp;+\u0026thinsp;was a significant risk factor for ICU admission, based on multivariate analysis (OR 1.01; 95% CI 1.00\u0026ndash;1.02; p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e4.4.2. Renal replacement therapy (RRT)\u003c/h2\u003e\u003cp\u003eIn the current study, (RRT) was significantly more frequent among CA-AKI\u0026thinsp;+\u0026thinsp;patients, although the number of cases was small. This aligns with Su et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], who reported a 1.6% dialysis rate and found an increased risk of RRT in patients with reduced kidney function. Specifically, those with an eGFR of 30\u0026ndash;44 ml/min/1.73m\u0026sup2; had a higher risk of RRT, and this risk increased further for patients with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30. However, due to the small sample size, the present study did not analyze the characteristics of patients who required RRT.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e4.4.3. Death from All Causes\u003c/h2\u003e\u003cp\u003eIn this study, death from all causes at 28 days was significantly more frequent in the CA-AKI\u0026thinsp;+\u0026thinsp;group. These patients had several confounding risk factors for death in addition to CA injection. This study does not allow for conclusions about the causality of CA in the death or whether it precipitated the death of these patients. Among comparable studies, the \"death\" criterion was not included in the analyses, making comparison impossible.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Overcrowding in EDs\u003c/h2\u003e\u003cp\u003eED overcrowding, an imbalance between patient volume and timely care[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], has worsened since COVID-19 and impacts all stages of patient flow\u0026mdash;entry, treatment, and discharge. It can lead to delayed exams, limited bed availability, and higher reconsultation rates, indicating inadequate initial care [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Studies show that ED congestion increases medical errors, delays resuscitation, and raises mortality, particularly when stays exceed four to five hours[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Prolonged wait times for imaging may contribute to CA-AKI, especially in patients with hypertension or chronic kidney disease, due to factors like dehydration and delayed treatment. Reducing imaging delays could help prevent CA-AKI and improve overall outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.6. Study Limitations\u003c/h2\u003e\u003cp\u003eThis retrospective, single-centre study shares common limitations with prior research. It only considered the first imaging exam within seven days and assumed early CA-AKI would be detected through routine follow-up. The study did not find a significantly higher incidence of CA-AKI. Antihypertensive drugs were grouped together, limiting insight into specific agents like loop diuretics, such as furosemide. Nephroprotective measures (e.g., hydration or stopping nephrotoxic medications) and the impact of oral hydration in metformin users were not analysed. Additionally, the study was not designed to assess causality between delayed imaging and subsequent renal failure. Further research is needed to explore these aspects.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eSevere chronic kidney disease (CKD, stage G4 or higher) is the only universally recognized risk factor for (CA-AKI). Routine pre-contrast creatinine testing is recommended in countries with a high prevalence of severe CKD but may be unnecessary for the French population, where severe CKD is less common. Instead, targeted biological testing for high-risk patients\u0026mdash;such as those with medical history of hypertension or advanced CKD would be more appropriate. For patients without risk factors, skipping pre-exam testing could help reduce hospital stays and lower associated morbidity and mortality, including CA-AKI.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAKIN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute Kidney Injury Network\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCA-AKI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContrast-Associated Acute Kidney Injury\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Kidney Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Kidney Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCE-CT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContrast Enhanced Computed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGFR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlomerular Filtration Rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eK+\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKalemia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKDIGO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney Disease Improval Global Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNa+\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNatremia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRenal Replacement Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe study was registered at ClinicalTrials.gov on 22 July 2025 (NCT07091656). \u003c/p\u003e\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe work conformed to the Declaration of Helsinki. The informed consent was waived by the institutional review board called Assistance Publique des H\u0026ocirc;pitaux de Paris Clinical Data Warehouse (AP-HP CDW) Scientific and Ethics Committee (Conseil Scientifique et Ethique; IRB number : 00011591).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors received no funding from an external source.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEL\u003c/strong\u003e: Data curation; Formal analysis; Investigation; Methodology; Visualization;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePradeebane VA:\u003c/strong\u003e Formal analysis; Supervision; Validation; Visualization; Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVV:\u003c/strong\u003e Methodology; Supervision; Validation; Writing - review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrabakar VA:\u003c/strong\u003e Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Supervision; Validation; Visualization; Roles/Writing - original draft; and Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDillenseger Jean-Philippe. Guide des technologies de l\u0026rsquo;imagerie m\u0026eacute;dicale et de la radioth\u0026eacute;rapie: quand la th\u0026eacute;orie \u0026eacute;claire la pratique / Jean-Philippe Dillenseger, Elisabeth Moerschel, Claudine Zorn ; illustrations, Jean-Philippe Dillenseger pr\u0026eacute;face \u0026agrave; la 2e \u0026eacute;dition Jean-Louis Dietemann. 2e \u0026eacute;dition. Issy-les-Moulineaux: Elsevier Masson; 2016. \u003c/li\u003e\n\u003cli\u003eBeer E. Uroselectan-Intravenous urography. Ann Surg. 1930;92:761\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eHartman GW. Uroselectan - Reactions accompanying its practical application: report of cases. Calif West Med. 1930;33:867\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eMoreau J-F, Droz D, Noel L-H. Nephrotoxicity of metrizamide in man. The Lancet. 1978;311:1201. \u003c/li\u003e\n\u003cli\u003eRudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. Kidney Int. 1995;47:254\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eRudnick et al. - 1995 - Nephrotoxicity of ionic and nonionic contrast medi.pdf. \u003c/li\u003e\n\u003cli\u003eJo S, Jeong T, Jin YH, Lee JB, Yoon J, Park B. ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study. Am J Emerg Med. 2015;33:1725\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eSartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, et al. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthc Basel Switz. 2022;10:1625. \u003c/li\u003e\n\u003cli\u003eDavenport MS, Khalatbari S, Dillman JR, Cohan RH, Caoili EM, Ellis JH. Contrast Material\u0026ndash;induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material. 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Lancet Lond Engl. 2017;389:1312\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eLocham S, Rodriguez A, Balceniuk MD, Mix D, Newhall K, Doyle A, et al. Contrast-Associated Acute Kidney Injury in High-Risk Patients Undergoing Peripheral Vascular Interventions. Vasc Endovascular Surg. 2023;57:583\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eYan P, Duan S-B, Luo X-Q, Zhang N-Y, Deng Y-H. Effects of intravenous hydration in preventing post-contrast acute kidney injury in patients with eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30 mL/min/1.73 m2. Eur Radiol. 2023;33:9434\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003ede Laforcade L, Bobot M, Bellin M-F, Cl\u0026eacute;ment O, Grang\u0026eacute; S, Grenier N, et al. Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging. 2021;102:131\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eCIRTACI, SFNDT. Fiche de recommandation pour la pratique clinique: rein et produit de contraste. Parue en 2020. \u003c/li\u003e\n\u003cli\u003eMehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med [Internet]. 2019 [cited 2021 Dec 14]; Available from: https://www-nejm-org.ezproxy.u-paris.fr/doi/10.1056/NEJMra1805256\u003c/li\u003e\n\u003cli\u003eKidney Disease Improving Global Outcomes, (KDIGO). Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1. \u003c/li\u003e\n\u003cli\u003eDaniel C, Paris N, Pierre O, Griffon N, Breant S, phane, et al. AP-HP Health Data Space (AHDS) to the Test of the Covid-19 Pandemic. Chall Trust AI Added-Value Health [Internet]. IOS Press; 2022 [cited 2025 Jun 6]. p. 28\u0026ndash;32. Available from: https://ebooks.iospress.nl/doi/10.3233/SHTI220390\u003c/li\u003e\n\u003cli\u003eFerrer Puchol MD, Montesinos Garc\u0026iacute;a P, Forment Navarro M, Sanz Rodrigo E, Blanco P\u0026eacute;rez E, Taberner L\u0026oacute;pez E. The administration of contrast media: is there a risk of acute kidney injury? Radiologia. 2019;61:306\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eESUR GUIDELINES ON CONTRAST AGENTS | esur.org [Internet]. [cited 2023 Nov 21]. Available from: https://www.esur.org/esur-guidelines-on-contrast-agents/\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. Hypertension Prevalence in the U.S. | Million Hearts\u0026reg; [Internet]. Cent. Dis. Control Prev. 2023 [cited 2023 Nov 21]. Available from: https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html\u003c/li\u003e\n\u003cli\u003eLu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1\u0026middot;7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet Lond Engl. 2017;390:2549\u0026ndash;58. \u003c/li\u003e\n\u003cli\u003ede Laforcade L, Bobot M, Bellin M-F, Cl\u0026eacute;ment O, Grang\u0026eacute; S, Grenier N, et al. Recommandations ESUR sur l\u0026rsquo;utilisation des produits de contraste : enqu\u0026ecirc;te de pratique, revue et commentaire par le CJN, le FIRN et la SFNDT. N\u0026eacute;phrologie Th\u0026eacute;rapeutique. 2021;17:80\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eBozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, et al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail. 2023;29:1412\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eGabet A, Blacher J, Pousset F, Grave C, Lailler G, Tuppin P, et al. Epidemiology of heart failure in France. Arch Cardiovasc Dis. 2024;117:705\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eConnelly PJ, Lonergan M, Soto-Pedre E, Donnelly L, Zhou K, Pearson ER. Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: A GoDarts study. Diabetes Obes Metab. 2017;19:1579\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eBell S, Farran B, McGurnaghan S, McCrimmon RJ, Leese GP, Petrie JR, et al. Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. BMC Nephrol. 2017;18:163. \u003c/li\u003e\n\u003cli\u003eCorchia A, Wynckel A, Journet J, Moussi Frances J, Skandrani N, Lautrette A, et al. Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study. Clin Toxicol Phila Pa. 2020;58:375\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eQiao H, Li Y, Xu B, Lu Z, Zhang J, Meng D, et al. Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis. Cardiology. 2022;147:469\u0026ndash;78. \u003c/li\u003e\n\u003cli\u003eAmerican College of Emergency Physicians (ACEP). Crowding. Policy statement. Ann Emerg Med. 2013;61:726\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eOuyang H, Wang J, Sun Z, Lang E. The impact of emergency department crowding on admission decisions and patient outcomes. Am J Emerg Med. 2022;51:163\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKwok E, Mackenzie T. A Novel Emergency Department Surge Protocol: Implementation of a Targeted Response Plan. J Clin Outcomes Manag JCOM. 2015;22:495\u0026ndash;503. \u003c/li\u003e\n\u003cli\u003eKenny JF, Chang BC, Hemmert KC. Factors Affecting Emergency Department Crowding. Emerg Med Clin North Am. 2020;38:573\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eEpstein SK, Huckins DS, Liu SW, Pallin DJ, Sullivan AF, Lipton RI, et al. Emergency department crowding and risk of preventable medical errors. Intern Emerg Med. 2012;7:173\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eJones S, Moulton C, Swift S, Molyneux P, Black S, Mason N, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J EMJ. 2022;39:168\u0026ndash;73. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute kidney injury, contrast media, tomography, Contrast-induced nephropathy","lastPublishedDoi":"10.21203/rs.3.rs-7357786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7357786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSince 1930 it has been accepted that intravenous injection of iodinated contrast agent as part of contrast-enhanced computed tomography (CE-CT) imaging can induce a contrast-associated acute kidney injury (CA-AKI). For the last 10 years, studies have investigated this iatrogenia. However, those works didn\u0026rsquo;t concern French population and particularly patient hospitalised after emergency department (ED) visit. This study assessed the CA-AKI incidence and factor risks in patients hospitalised after a CE-CT in ED.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e\u003cp\u003eThis was a monocentric retrospective study, conducted in a University Hospital ED (Beaujon Hospital) between 2019 and 2022. Patients over 16 years old who received a CE-CT and two serum creatinine dosages, one pre-CT and one post-CT (2 to 7 days later), were included. Risk factors and protective factors of CA-AKI as well as population characteristics were analysed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAfter studying 5079 enhanced CT-scans, 1463 patients fulfilled the inclusion criteria. The incidence of CA-AKI was 4.1%. The associated risk factors were: hypertension (adjusted odds ratio (aOR)\u0026thinsp;=\u0026thinsp;3.36, 95% confidence interval (CI) (1.76\u0026ndash;6.43)), CKD grade 4\u0026ndash;5 (aOR\u0026thinsp;=\u0026thinsp;5.89, 95% CI (1.39\u0026ndash;24.95)), waiting time before CT (aOR\u0026thinsp;=\u0026thinsp;3.36, 95% CI (1.76\u0026ndash;6.43)). Ongoing treatment by metformin was found to be a protective factor (aOR\u0026thinsp;=\u0026thinsp;0.26, 95% CI (0.06\u0026ndash;1.12)).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIt appeared that only hypertension and CKD grade 4\u0026ndash;5 were risk factors for CA-AKI. Their absence would allow performing a CE-CT without waiting for kidney function levels. This consideration could reduce patient length of stay and the associated morbidity and mortality.\u003c/p\u003e","manuscriptTitle":"Incidence and risk factors of contrast-associated acute kidney injury in patients hospitalised after contrast-enhanced computed tomography in the Emergency Department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:10:49","doi":"10.21203/rs.3.rs-7357786/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-09T16:19:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T10:11:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T17:03:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153074103911046699693750162525389646258","date":"2025-10-01T04:57:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39620934126678857043719173009758885703","date":"2025-09-29T20:42:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T15:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250897942501529431605691436124595662150","date":"2025-09-14T22:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17574420764175019762808746696463976259","date":"2025-09-12T13:55:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-20T00:43:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T12:39:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T12:39:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2025-08-12T16:13:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0c300d9-64f8-4a49-bafa-c8467934069f","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:02:25+00:00","versionOfRecord":{"articleIdentity":"rs-7357786","link":"https://doi.org/10.1186/s12245-025-01058-0","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2025-12-29 15:58:32","publishedOnDateReadable":"December 29th, 2025"},"versionCreatedAt":"2025-09-01 09:10:49","video":"","vorDoi":"10.1186/s12245-025-01058-0","vorDoiUrl":"https://doi.org/10.1186/s12245-025-01058-0","workflowStages":[]},"version":"v1","identity":"rs-7357786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7357786","identity":"rs-7357786","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}