Rogliano Pierre-François, Voicu Sebastian, Labat Laurence, Deye Nicolas, Malissin Isabelle, Laplanche Jean-Louis, Vodovar Dominique, Mégarbane Bruno
Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France.
Inserm UMRS 1144, University of Paris, 75010 Paris, France.
Toxics. 2020 Sep 28;8(4):79. doi: 10.3390/toxics8040079.
Acute kidney injury (AKI) is the major complication of rhabdomyolysis. We aimed to identify the predictive factors for AKI and renal replacement therapy (RRT) requirement in poisoning-associated rhabdomyolysis. We conducted a cohort study including 273 successive poisoned patients (median age, 41 years) who developed rhabdomyolysis defined as creatine kinase (CK) >1000 IU/L. Factors associated with AKI and RRT requirement were identified using multivariate analyses. Poisonings mainly involved psychotropic drugs. AKI occurred in 88 patients (37%) including 43 patients (49%) who required RRT. Peak serum creatinine and CK were weakly correlated ( = 0.17, < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, < 0.001). On admission, lithium overdose (OR, 44.4 (5.3-371.5)), serum calcium ≤2.1 mmol/L (OR, 14.3 (2.04-112.4)), female gender (OR, 5.5 (1.8-16.9)), serum phosphate ≥1.5 mmol/L (OR, 2.0 (1.0-4.2)), lactate ≥ 3.3 mmol/L (OR, 1.2 (1.1-1.4)), serum creatinine ≥ 125 µmol/L (OR, 1.05 (1.03-1.06)) and age (OR, 1.04 (1.01-1.07)) independently predicted AKI onset. Calcium-channel blocker overdose (OR, 14.2 (3.8-53.6)), serum phosphate ≥ 2.3 mmol/L (OR, 1.6 (1.1-2.6)), Glasgow score ≤ 5 (OR, 1.12; (1.02-1.25)), prothrombin index ≤ 71% (OR, 1.03; (1.01-1.05)) and serum creatinine ≥ 125 µmol/L (OR, 1.01; (1.00-1.01)) independently predicted RRT requirement. We identified the predictive factors for AKI and RRT requirement on admission to improve management in poisoned patients presenting rhabdomyolysis.
急性肾损伤（AKI）是横纹肌溶解症的主要并发症。我们旨在确定中毒相关性横纹肌溶解症患者发生AKI及需要肾脏替代治疗（RRT）的预测因素。我们进行了一项队列研究，纳入了273例连续发生横纹肌溶解症（定义为肌酸激酶（CK）>1000 IU/L）的中毒患者（中位年龄41岁）。通过多因素分析确定与AKI及RRT需求相关的因素。中毒主要涉及精神药物。88例患者（37%）发生AKI，其中43例患者（49%）需要RRT。血清肌酐峰值与CK呈弱相关（r = 0.17，P < 0.001）。AKI发病后死亡（13%）更为常见（32% vs. 2%，P < 0.001）。入院时，锂过量（比值比（OR），44.4（5.3 - 371.5））、血清钙≤2.1 mmol/L（OR，14.3（2.04 - 112.4））、女性（OR，5.5（1.8 - 16.9））、血清磷酸盐≥1.5 mmol/L（OR，2.0（1.0 - 4.2））、乳酸≥3.3 mmol/L（OR，1.2（1.1 - 1.4））、血清肌酐≥125 µmol/L（OR，1.05（1.03 - 1.06））和年龄（OR，1.04（1.01 - 1.07））独立预测AKI发病。钙通道阻滞剂过量（OR，14.2（3.8 - 53.6））、血清磷酸盐≥2.3 mmol/L（OR，1.6（1.1 - 2.6））、格拉斯哥昏迷评分≤5（OR，1.12；（1.02 - 1.25））、凝血酶原指数≤71%（OR，1.03；（1.01 - 1.05））和血清肌酐≥125 µmol/L（OR，1.01；（1.00 - 1.01））独立预测RRT需求。我们确定了入院时AKI及RRT需求的预测因素，以改善对出现横纹肌溶解症的中毒患者的管理。
