Our aim was to identify predictive factors on admission of
poisoning severity and based on an evaluation of practice, report indications for ECTR susceptible to improve outcome Methods: We performed a retrospective cohort study including all
lithium-poisoned patients admitted to the ICU in a university hospital. The usual clinical,
biological and toxicological variables were collected.
Poisoning severity was defined by
seizures,
catecholamine infusion,
mechanical ventilation >48 h and/or fatality. Univariate followed by multiple logistic regression analyses were performed to identify prognosticators of
poisoning severity and ECTR use.
RESULTS: From 1992 to 2013, 128
lithium-poisoned patients including acutely (10%), acute-on-chronically (63%) and chronically poisoned patients (27%) were included. The presumed ingested dose of
lithium was 17.0 g [8.0-24.5] (median [25th-75th percentiles]). Serum
lithium concentrations were 2.6 mmol/l [1.5-4.6], 2.8 mmol/l [1.8-4.5] and 2.8 mmol/l [2.1-3.0] on admission, peaking at 3.6 mmol/l [2.6; 6.2], 4.3 mmol/l [2.4; 6.2] and 2.8 mmol/l [2.1; 3.1] in the three groups, respectively. Severe
poisoning occurred in 48 patients (38%) including four fatalities. Using the regression analysis, predictive factors of
poisoning severity were Glasgow
coma score ≤10 (Odds ratio (OR), 11.1; 95% confidence interval (CI), [4.1-33.3], p < 0.0001) and
lithium concentration ≥5.2 mmol/l (OR, 6.0; CI, [1.7-25.5], p = 0.005). Ninety-eight patients (77%) developed
acute kidney injury according to KDIGO criteria and 22 (17%) were treated with ECTR. Peak
lithium concentration ≥5.2 mmol/l (OR, 22.4; CI, [6.4-96.4]; p < 0.0001) and peak
creatinine concentration ≥200 μmol/l (OR, 5.0; CI, [1.4-19.2]; p = 0.01) were associated with ECTR use. Only 21/46 patients who presented one of these two criteria were actually treated with ECTR. More significant neurological impairment persisted on discharge in patients not treated with ECTR (p = 0.0007) despite not significantly shorter length of ICU stay.
CONCLUSIONS: