Acute Kidney Injury in Patients With Suspected Pulmonary Embolism: A Retrospective Study of the Incidence, Risk Factors, and Outcomes in a Tertiary Care Hospital in Saudi Arabia

Abstract

Background Pulmonary embolism (PE) is a known cause of morbidity and mortality. A diagnosis of PE is made by computed tomography pulmonary angiogram (CTPA) or a ventilation-perfusion (V/Q) scan. This study aimed to assess the incidence and predictors of acute kidney injury (AKI) in patients with suspected PE. Methods This study was a retrospective study including patients with suspected PE who underwent a CTPA and/or a V/Q scan from 2015 to 2020. The patients were grouped into CTPA or V/Q scan. Creatinine levels were obtained before and after the procedure. AKI was defined based on an increased serum creatinine by 0.3 mg/dL within 48 hours. Results A total of 752 patients were included in the study. The majority (n = 688) underwent a CTPA as a diagnostic modality in patients suspected to have pulmonary embolism (PE), and a V/Q scan was used in 73 patients. Of the 752 patients, there were eight patients who underwent both diagnostic modalities. PE was diagnosed in 121 (16.1%) patients. The incidence of AKI was observed in 15.8%. PE was suspected more frequently in the female group (n = 481, 64%), with a 50% reduction of AKI risk, compared with the male group (p-value = 0.004, OR = 0.522, 95% CI = 0.337-0.81). The presence of diabetes mellitus (DM) and hypertension (HTN) was associated with AKI (p-value < 0.001). Of the AKI group, 43 (36.1%) patients had malignancy. The presence of malignancy was a predictor of increased AKI risk (p-value = 0.014, OR = 1.74, 95% CI = 1.21-2.70). A small proportion (2.1%, n = 16) required dialysis. Patients who developed AKI had a 30-day mortality of 20.2% compared with 5.1% for the group without AKI. Conclusion In our sample, clinicians suspected PE more frequently in the female group. The overall incidence rate of AKI in patients suspected of having PE was 16.1%. The presence of diabetes mellitus and hypertension was associated with AKI. However, DM and HTN were not predictors of AKI. The risk of AKI requiring dialysis was relatively low (2.1%). There was no relationship between the diagnostic modalities and PE, and AKI, suggesting that clinicians overestimate the fear of contrast-induced AKI (CI-AKI). Copyright © 2022, Alhassan et al.