Predictors of acute adverse reactions to non-ionic iodinated contrast media in CT imaging: a systematic review and meta-analysis.

BACKGROUND

Iodinated contrast media-acute adverse reactions (ICM-AARs) are frequent and clinically significant complications associated with radiological imaging. Despite investigation of their risk factors, there is no consensus, and no comprehensive synthesis has been conducted. This systematic review and meta-analysis aimed to investigate the factors influencing ICM-AARs.

METHODS

A systematic search for studies published in Chinese or English up to 22 July 2024 in the PubMed, Web of Science, Cochrane Library, Embase, CNKI, WanFang, CQVIP, and SinoMed databases was conducted. Studies on patients undergolng contrast-enhanced CT examinations with nonionic ICM were selected. The primary outcome measures were risk factors associated with ICM-AARs. The studies were analyzed for heterogeneity using the Q-test and I2 statistic, while publication bias was assessed using funnel plots, Egger's test, and Begg's test. Stata 17 software was used for the meta-analysis.

RESULTS

Seventeen studies were included, encompassing 2,576,446 CT-enhanced examinations. Of these, 11,621 acute adverse reactions were reported, with a mean incidence of 0.45% and a quality score of ≥7. The meta-analysis showed that female sex (OR = 1.27, 95% CI = 1.13, 1.41), age <35 years (OR = 1.77, 95% CI = 1.19, 2.64), high body mass index (OR = 1.06, 95% CI = 1.01, 1.10), type of medical visit (outpatient) (OR = 2.23, 95% CI = 1.01, 4.93), history of adverse ICM reactions (OR = 11.03, 95% CI = 2.25, 53.97), history of other allergies (OR = 3.16, 95% CI = 1.27, 7.84), history of asthma (OR = 1.75, 95% CI = 1.19, 2.57), hyperthyroldism (OR = 4.59, 95% CI = 1.65, 12.82), and type of ICM (OR = 2.27, 95% CI = 1.68, 3.06) were risk factors for ICM-AARs. Age >60 years (OR = 0.71, 95% CI = 0.53, 0.95), pre-injection medication (OR = 0.56, 95% CI = 0.39, 0.79), and hypertensive disorders (OR = 0.78, 95% CI = 0.65, 0.94) were identified as protective against ICM-AARs.

CONCLUSIONS

The incidence of ICM-AARs is influenced by a variety of clinical and demographic factors. Healthcare professionals may benefit from dynamically assessing patient-specific risk factors and considering targeted preventive measures for high-risk groups, particularly in populations similar to those studied.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42024571470).