1-Year Mortality Following Contrast-Induced Nephropathy
Alice M. Mitchell,
Alan E. Jones,
James A. Tumlin,
Jeffrey A. Kline
Issue:
Volume 1, Issue 1, May 2013
Pages:
1-6
Received:
23 April 2013
Published:
2 May 2013
Abstract: Objective: The aim of this study was to determine the 1-year mortality risk subsequent to Contrast-Induced Nephropathy (CIN) following CECT imaging, relative to other well-recognized predictors of mortality. Methods: We followed a prospective, consecutive cohort of ambulatory patients who received intravenous contrast for CECT for the outcome of death from any cause within 1 year. In a multivariate analysis, we compared CIN with other predictors of mortality: active malignancy, coronary artery disease (CAD), congestive heart failure (CHF) and age ≥70 years. Anticipating that terminal cancers would account for the majority of deaths in this population, we also analyzed the subset of patients without an active malignancy at the time of enrollment. Results: We followed 633 patients and 46 died (7%, 95%CI: 5-9%) within 1 year. The incidence of CIN was 11% (95%CI: 8-14%). Active malignancy (HR 9.2, 95%CI: 5.1-16.8), CIN (HR 2.4, 95%CI: 1.3-4.6), CHF (HR 2.1, 95%CI: 1.0-4.2), CAD (HR 2.2, 95%CI: 1.0-5.5) and age ≥70 years (HR 1.8, 95%CI: 1.0-3.8) were significant predictors of all-cause mortality. Among patients without active malignancies, the mortality rate was 4% (25/580, 95%CI: 3-6%) and CIN (HR 4.0, 95%CI: 1.7-9.6) and age ≥70 years (HR 3.7, 95%CI: 1.4-9.7) were significantly associated with death, whereas CAD (HR 2.5, 95%CI: 0.8-7.7) and CHF (HR 1.8, 95%CI: 0.6-5.3) were not. Conclusions: The development of CIN following CECT is associated with an increased likelihood of death at 1 year among patients with and without active malignancies, comparable to CAD, CHF and advanced age.
Abstract: Objective: The aim of this study was to determine the 1-year mortality risk subsequent to Contrast-Induced Nephropathy (CIN) following CECT imaging, relative to other well-recognized predictors of mortality. Methods: We followed a prospective, consecutive cohort of ambulatory patients who received intravenous contrast for CECT for the outcome of de...
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Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic
Akhila Kumar Panda,
Muralikrishnan K,
Garima Sarraf,
Seema Mallik
Issue:
Volume 1, Issue 1, May 2013
Pages:
7-9
Received:
13 May 2013
Published:
10 June 2013
Abstract: Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.
Abstract: Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of he...
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