Prospective evaluation of risk factors for acute adverse reactions to iodinated contrast media in contrast-enhanced CT

ObjectiveThis study aimed to identify clinical risk factors for acute adverse reactions (AARs) to iodinated contrast media (ICM) during contrast-enhanced CT.MethodsIn this prospective study, A total of 1,462 patients with contrast-enhanced CT scans were continuously enrolled between October and December 2020 in a Class A tertiary cardiovascular specialty hospital. Blood samples were collected before the scan to determine serum immunoglobulin E (IgE), eosinophil (EOS) counts, and glucose levels. Demographic data and clinical characteristics were extracted from the hospital information system and pre-designed case report forms. Multivariate Firth logistic regression and receiver operating characteristic (ROC) analyses for these factors were performed to assess predictors of AARs.ResultsAmong 1,462 patients, 62 (4.24%) experienced AARs, including 20 (1.37%) acute allergic-like reactions. Cardiac insufficiency (OR = 1.983, 95% CI: 1.115–3.525), age (OR = 0.980, 95% CI: 0.961–0.999), ICM type (OR = 2.221, 95% CI: 1.320–3.737), CT examination type (OR = 0.492, 95% CI: 0.289–0.837), prior ICM reaction history (OR = 35.411, 95% CI: 6.408–195.700), and allergy history (OR = 3.327, 95% CI: 1.655–6.688) were independent risk factors for AARs. Hyperlipidemia might be potentially associated with AARs. Elevated baseline IgE, ICM type, and gout might be potentially associated with acute allergic-like reactions. EOS and blood glucose levels showed no significant association.ConclusionCardiac insufficiency, age, ICM type, CT examination type, prior ICM reactions, and allergy history are key risk factors for AARs. The following exploratory associations require multi-center validation: hyperlipidemia may have a potential association with AARs; baseline IgE levels, ICM type and gout may be associated with acute allergic-like reactions.