Adverse reactions to CT contrast media: incidence, severity and risk factors

Transcription

1 Adverse reactions to CT contrast media: incidence, severity and risk factors Poster No.: C-0827 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit S. Lee, K. Bae, K. N. Jeon; Jinju/KR Contrast agents, CT, CT-Angiography, Contrast agentintravenous, Outcomes /ecr2014/C-0827 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Aims and objectives Computed tomography (CT) imaging has rapidly become a commonplace diagnostic tool due to its utility in a wide range of diseases. Contrast media (CM) are intravascular pharmaceuticals that are used in approximately 75 million procedures annually. Some years ago non-ionic iodinated contrast agents largely replaced ionic agents, due to their better safety profile. To evaluate the incidence, severity and risk factors of adverse reaction to IV administration of non-ionic iodinated contrast media in computed tomography. Methods and materials We prospectively recorded all adverse contrast reactions (ACRs) to intravenous CT contrast media in consecutive outpatients who underwent contrast enhanced CT examinations between June 2010 and May The electronic medical record was reviewed for the age, gender, premedications for patients with a prior history of contrast allergy, time of CT study, symptoms, signs and management of the reactions of the patients. The contrast media used in procedures included Iopromide, Iomepril, and Iodixanol. The severity of allergy was classified as mild, moderate and severe using the grading system in the ACR Manual on Contrast Media (version 7, 2010) Spring is defined as March to May; Summer, June to August; Autumn, October to November and Winter, December to February. Chi-square statistics was used for categorical data to test a significant association between the contrast reaction group and these categorical variables. To quantify a magnitude of the association, odds ratios (ORs) were calculated. The p-value of 0.05 was taken as statistically significant. Results Page 2 of 8

3 A total of 191 patients had adverse reactions (0.35%). 157 (82%) were categorized as mild reaction, 29 (15%) as moderate and 5 (3%) as severe ( Table1). No deaths during this period were attributed to contrast media. The rate of adverse reactions was significantly higher in female patients (Chi-Squared test, p <0.001 ). The odds ratio was 2.16 (p <0.001) (Table2). The rate of adverse reactions was significantly higher in the patients under the age of 60 years (0.41%) than the patients over 60 (0.27%) (Chi-Squared test, p = ). The odds ratio was 1.55 (p=0.004) (Fig.2). Rate of ACRs peaked in March (Fig.3). In the ACRs group, 65 (34%) occurred in spring, 51 (27%) in summer, 35 (18%) in autumn and 40 (21%) in winter (Table 3). The rate of adverse reactions was significantly higher in spring(0.44%, 65 of 14629), than other seasons(0.32%, 126 of 39943) (Chi-Squared test, p =0.03). The odds ratio was 1.41 ( p = 0.025) (Fig.4). Premedication with antihistamine (ex.pheniramine IV), either alone or in combination with corticosteroid(ex.dexamethasone IV), was used in patients that have previously experienced ACRs. Hypersensitivity reactions were not prevented in 8 of the 247 who had experienced prior ACRs (overall recurrence rate after premedication 3.2%) (Table 4). Images for this section: Table 1: Severity of adeverse contrast reactions to contrast media. Page 3 of 8

4 Table 2: Reaction rates by sex (n = 191). Table 3: Comparison of adverse contrast reactions (ACR) and contrast enhanced CT studies (CE-CT) by seasons. Table 4: Outcome of premedication. Fig. 1: Ratios of adverse constrast reactions(acr) by age band. Page 4 of 8

5 Fig. 2: Ratios of adverse constrast reactions(acrs) by age (#60, >60). The odd ratios of younger than 60-years old to older than 60-years old was 1.55, p = Fig. 3: Ratios of adverse contrast reactions (ACR) by month. Page 5 of 8

6 Fig. 4: Ratios of adverse contrast reactions (ACRs) by seasons (spring vs other seasons). The odd ratios of spring to other seasons was 1.41, p = Page 6 of 8

7 Conclusion The incidence of adverse reactions to CT contrast media was 0.35% and mostly mild reactions (85%). Risk factors for adverse reactions were female gender, age under 60 years and spring season. Overall recurrence rate after premedication was 3.2%. Personal information Kyungsoo Bae MD Sangmin Lee MD Kyung Nyeo Jeon MD Department of Radiology, Gyeongsang National University, Jinju, South Korea. References 1. Christiansen. C. X-ray contrast media-an overview. Toxicology 2005;209: Lesser EC. Anaphylaxis. Novartis Found Symp 2004;257: ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. Version 7. Table 3. Categories of reactions p Kim SH, Lee SH, Lee SM, Kang HR, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS. Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur J Radiol Nov;80(2): Jonathan Ho, Roger J. Kingston, Noel Young, Constance H. Katelaris, and Doungkamol Sindhusake. Immediate hypersensitivity reactions to IV non-ionic iodinated contrast in computed tomography. Asia Pac Allergy Oct;2(4): ] 6. Brockow K, Christiansen C, Kanny G, et al. Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005;60(2): Lasser EC, Berry CC, Mishkin MM, et al. Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media, Prophylaxis for anaphylactoid reactions Page 7 of 8

8 in high risk patients receiving radiopaque contrast media. AJR Am J Roentgenol 1994;162(3): Page 8 of 8