Renal venous density in the arterial phase of contrast-enhanced CT predicts prognosis in septic shock

Abstract

Objective: To evaluate a series of vascular parameters derived from abdominal dual-phase contrast-enhanced CT as predictors of 14-day mortality and AKI within 7 days in septic shock.

Methods: 144 patients with septic shock and 60 negative cases were included. The vascular parameters from CT were measured and calculated, including aortic density in arterial (Den_a-A) and venous phase (Den_a-V), renal vein density in arterial (Den_rv-A) and venous phase (Den_rv-V), and renal vein-to-aortic density ratio in arterial (DenR_rv/a-A) and venous phase (DenR_rv/a-V). The parameters were compared between patients and controls, and between patients with different clinical outcomes, and assessed for predictive value of 14-day mortality and AKI within 7 days.

Results: Patients with septic shock presented significantly lower Den_rv-A (p < 0.001) and DenR_rv/a-A (p = 0.002) levels than the controls. In the septic shock group, patients who died had significantly lower Den_rv-A (p = 0.001) and lower DenR_rv/a-A (p < 0.001) than those who survived. Patients who developed AKI had significantly lower Den_rv-A (p < 0.001) and DenR_rv/a-A (p = 0.011) than those who did not. Multivariate analysis suggested DenR_rv/a-A as an independent predictor of 14-day mortality (OR 0.012; 95% confidence interval [CI]:0.002,0.086; p < 0.001) and Den_rv-A as an independent predictor of AKI (OR 0.989;95% CI:0.982,0.997; p = 0.006).

Conclusion: In septic shock, significant decreases in Den_rv-A and DenR_rv/a-A were associated with the onset of AKI and predicted higher 14-day mortality.

Advances in knowledge: The renal vein density and renal vein-aortic density ratio in arterial phase of dual-phase contrast-enhanced CT may serve as good predictors of AKI and mortality in septic shock.