(1330) Risk of Post-Contrast Acute Kidney Injury in Critically Ill Patients With Sepsis in South Africa

Introduction: Nephrotoxicity of contrast media and the resultant acute kidney injury (AKI) is a well-studied concept, but data is scarce on other comorbidities such as sepsis, a frequent cause of morbidity and mortality in ICU, which may worsen this outcome. Our study investigates the association between contrast media and sepsis in the development of AKI among South African ICU patients.

Methods: We performed a retrospective analysis of the observational dataset LIVAKI 2017, a publicly available dataset which included 849 patients from a multi-disciplinary ICU in South Africa. Using AKI as the outcome, multivariable logistic regression models were used to assess the effect of sepsis and contrast media on AKI in these patients. Potential interaction between sepsis and contrast media was also assessed in a separate logistic model.

Results: Of the total sample (N=849), 256 patients (30.2%) had sepsis, 71 patients (8.4%) received contrast media. Mean age was 42.5 years, 59.8% male. Race is made up of Black (58%), White (13.8%), Colored (27.4%), Indian (5%), Asian/Other (2%). Using a multivariate regression, we found that contrast media and sepsis are independently associated with the development of acute kidney injury, adjusting for age, diabetes, race, gender, chronic kidney disease, hypertension, vasopressor. We found that contrast media (OR=6.77, 95% CI=2.83-15.94; P<=0.001) and sepsis (OR=1.77, 95% CI=1.12-2.82; P=0.015) were associated with an increased risk of AKI; however, the interaction between contrast media and sepsis was not significant (OR=1.04, 95% CI=0.12-9.41; P=0.973). Of the 32 patients who had sepsis and were also treated with contrast media, 31 developed AKI. In addition, we found that patients with diabetes (OR=1.88, 95% CI=1.09-3.23; P=0.023) and those requiring vasopressor (OR=1.86, 95% CI=1.02-3.42; P=0.045) were more likely to have acute kidney injury.

Conclusions: In our sample population, we found that sepsis and contrast media were independently associated with increased risk of AKI. The small sample size in our study limits the assessment of an interaction effect between sepsis and contrast media. We recommend future studies with larger sample size to further evaluate this interaction.