Predictive Role of Pretest Probability Scores and Risk Factors of Contrast-Induced Acute Kidney Injury in Patients Who Underwent CT Pulmonary Angiography for the Suspicion of Pulmonary Embolism

Abstract

BACKGROUND AND AIM: The use of computed tomographic pulmonary angiogram (CTPA) without determining pretest probability leads to overuse and morbidities as contrast-induced acute kidney injury (CI-AKI). We aimed to assess the predictive role of Wells' rule and revised Geneva scores together with the D-dimer test in patients who underwent CTPA for the suspicion of pulmonary embolism (PE) and to investigate the frequency of CI-AKI. METHODS: This single-center study was conducted as a retrospective analysis of patients who underwent CTPA. Demographic and clinical variables, risk factors, pretest probability score (PPS), and biomarkers were recorded from written or electronic medical records. RESULTS: A total of 1259 CTPA scans performed for suspicion of acute PE were screened. After exclusion, we analyzed 895 CTPAs. PE rates in the emergency department and in-patient wards were 9.1% and 13.9%, respectively. Immobility, high Wells' rule, and Geneva scores were found to be predictors of PE. The [OR (95% CI)] were [12.92 (4.38-38.14)], p<0.001; [7.55 (1.96-28.61)], p<0.001; and [1.25 (1.07-1.39)], p=0.003, respectively. The diagnostic sensitivity of Wells' rule and Geneva score for PE was 24.6% and 68.1%, respectively, while the diagnostic specificity for PE was 91.4% and 42.7% for Wells' rule and revised Geneva score, respectively. CI-AKI was detected in 99 (20.7%) of 479 patients, and the history of myocardial infarction within 3 months was the only predictor of CI-AKI [OR (95% CI)] [6.30 (1.46-27.90)], p=0.014. CONCLUSIONS: D-dimer test and usage of PPS for patients considered PE may reduce overuse of CTPA and thereby CI-AKI prevalence.