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Article

Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement

1
Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France
2
Inserm UMRS 1144, University of Paris, 75010 Paris, France
3
Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France
4
Laboratory of Biochemistry, Federation of Toxicology APHP, Lariboisière Hospital, University of Paris, 75010 Paris, France
*
Author to whom correspondence should be addressed.
Toxics 2020, 8(4), 79; https://doi.org/10.3390/toxics8040079
Received: 22 August 2020 / Revised: 21 September 2020 / Accepted: 25 September 2020 / Published: 28 September 2020
(This article belongs to the Section Toxicology)
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 (R2 = 0.17, p < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, p < 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. View Full-Text
Keywords: acute kidney injury; poisoning; predictive factor; renal replacement therapy; rhabdomyolysis acute kidney injury; poisoning; predictive factor; renal replacement therapy; rhabdomyolysis
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MDPI and ACS Style

Rogliano, P.-F.; Voicu, S.; Labat, L.; Deye, N.; Malissin, I.; Laplanche, J.-L.; Vodovar, D.; Mégarbane, B. Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement. Toxics 2020, 8, 79. https://doi.org/10.3390/toxics8040079

AMA Style

Rogliano P-F, Voicu S, Labat L, Deye N, Malissin I, Laplanche J-L, Vodovar D, Mégarbane B. Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement. Toxics. 2020; 8(4):79. https://doi.org/10.3390/toxics8040079

Chicago/Turabian Style

Rogliano, Pierre-François, Sebastian Voicu, Laurence Labat, Nicolas Deye, Isabelle Malissin, Jean-Louis Laplanche, Dominique Vodovar, and Bruno Mégarbane. 2020. "Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement" Toxics 8, no. 4: 79. https://doi.org/10.3390/toxics8040079

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