Risk factors for adverse reactions from contrast agents for computed tomography

Abstract

BackgroundSymptoms of an adverse reaction to contrast agents for computed tomography are diverse ranging, and sometimes serious. The goal of this study is to create a scoring rule to predict adverse reactions to contrast agents used in computed tomography.MethodsThis was a retrospective cohort study of all adult patients undergoing contrast enhanced CT scan for 7 years. The subjects were randomly divided into either a derivation or validation group. Baseline data and clinically relevant factors were collected from the electronic chart. Primary outcome was any acute adverse reactions to contrast media, observed for during 24 hours after administration. All potential candidate predictors were included in a forward stepwise logistic regression model. Prediction scores were assigned based on β coefficient. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and incidence of acute adverse reactions at each point were obtained. The same process was performed in the validation group.Results36,472 patients underwent enhanced CT imaging: 20,000 patients in the derivation group and 16,472 in the validation group. A total of 409 (2.0%, 95% CI:1.9-2.3) and 347 (2.1%, 95% CI:1.9-2.3) acute adverse reactions were seen in the derivation and validation groups. Logistic regression analysis revealed that prior adverse reaction to contrast agents, urticaria, an allergic history to drugs other than contrast agents, contrast agent concentration >70%, age <50 years, and total contrast agent dose >65 g were significant predictors of an acute adverse reaction. AUC was 0.70 (95% CI:0.67-0.73) and 0.67 (95% CI:0.64-0.70) in the derivation and validation groups.ConclusionsWe suggest a prediction model consisting of six predictors for acute adverse reactions to contrast agents used in CT.

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

“…Several methods have been used to prevent hypersensitivity to LOCM [27][28][29]. A previous history of hypersensitivity to LOCM is a major risk factor for further hypersensitivity [30], and several preventive strategies have been used in at-risk patients. Accurate documentation of the contrast agent that induced the response and history of iodine allergy should be evaluated [31], because a previous history of hypersensitivity is the main risk factor.…”

“…Several other risk factors for hypersensitivity to LOCM have been identified [23,30,41,42]. In addition to past history of hypersensitivity, the presence of allergic disease, female gender, and younger age are associated with an increased risk of HSRs.…”

Imaging Modalities for Assessment of Treatment Response to Nonsurgical Hepatocellular Carcinoma Therapy: Contrast-Enhanced US, CT, and MRI

“…Kobayashi et al reported in their large-scale study that the prevalence of all adverse reactions to nonionic contrast media was 2% and that of severe reactions was 0.1% [65]. The vast majority of these reactions were mild, including rash/hives, itching, nausea with or without vomiting, cough, or lump in the throat, among others.…”

Optimal management of acute nonrenal adverse reactions to iodine-based contrast media

“…A recent study found an incidence rate of 0.0005%-0.0008% for severe reactions for nonionic contrast media. 5 Fatal reactions to both groups of iodine-based contrast media are very rare (1:170,000), with no difference in mortality reported between the two groups. 3,10,11 Physiological factors may also influence the incidence of acute adverse reactions.…”

“…4 These observations have recently been confirmed in a large study of over 36,000 patients undergoing contrast-enhanced computed tomography with different nonionic agents. 5 The study showed that six factors are predictors of acute adverse reactions: (1) a history of adverse reaction to contrast media; (2) a history of urticaria; (3) any drug allergy; (4) a contrast media concentration .70%; (5) patient age under 50 years; and (6) a total contrast media dose above 65 g.…”