Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.

Why are we performing fewer cholecystectomies for mild acute biliary pancreatitis?Trends and predictors of cholecystectomy from the National Readmissions Database(2010–2014)

Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.