Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study.
Acute Kidney Injury
/ epidemiology
Adult
Female
France
/ epidemiology
Hematinics
/ pharmacology
Humans
Hydroxocobalamin
/ pharmacology
Intensive Care Units
/ organization & administration
Male
Middle Aged
Odds Ratio
Retrospective Studies
Smoke
/ adverse effects
Smoke Inhalation Injury
/ drug therapy
Acute kidney injury
Burn
Hydroxocobalamin
Intensive care unit
Mortality
Smoke inhalation
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
23 Dec 2019
23 Dec 2019
Historique:
received:
06
09
2019
accepted:
16
12
2019
entrez:
25
12
2019
pubmed:
25
12
2019
medline:
2
6
2020
Statut:
epublish
Résumé
The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. ClinicalTrials.gov, NCT03558646.
Sections du résumé
BACKGROUND
BACKGROUND
The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored.
METHODS
METHODS
We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models.
RESULTS
RESULTS
Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively.
CONCLUSION
CONCLUSIONS
Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, NCT03558646.
Identifiants
pubmed: 31870461
doi: 10.1186/s13054-019-2706-0
pii: 10.1186/s13054-019-2706-0
pmc: PMC6929494
doi:
Substances chimiques
Hematinics
0
Smoke
0
Hydroxocobalamin
Q40X8H422O
Banques de données
ClinicalTrials.gov
['NCT03558646']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
421Subventions
Organisme : Union des Blessés de la Face et de la Tête
ID : 2014
Références
Ann Emerg Med. 2007 Jun;49(6):794-801, 801.e1-2
pubmed: 17481777
Crit Care Med. 2018 Jun;46(6):e523-e529
pubmed: 29543597
Surg Endosc. 2004 Sep;18(9):1377-9
pubmed: 15164282
Stat Methods Med Res. 2015 Aug;24(4):462-87
pubmed: 24525487
Nat Rev Nephrol. 2017 Sep;13(9):593
pubmed: 28757637
Chest. 2016 Dec;150(6):1260-1268
pubmed: 27316558
N Engl J Med. 1996 Nov 21;335(21):1581-6
pubmed: 8900093
Am J Physiol Renal Physiol. 2009 May;296(5):F1109-17
pubmed: 19225052
Anesthesiology. 2018 Sep;129(3):583-589
pubmed: 29958240
Eur J Emerg Med. 2013 Feb;20(1):2-9
pubmed: 22828651
Crit Care Med. 2002 Sep;30(9):2044-50
pubmed: 12352039
Mol Med. 2008 Jul-Aug;14(7-8):502-16
pubmed: 18488066
Burns. 2017 Feb;43(1):107-113
pubmed: 27554631
Scand J Trauma Resusc Emerg Med. 2011 Mar 03;19:14
pubmed: 21371322
World J Methodol. 2015 Jun 26;5(2):88-100
pubmed: 26140275
Intensive Care Med. 2016 Jun;42(6):1080-1
pubmed: 26891675
Clin Toxicol (Phila). 2006;44 Suppl 1:37-44
pubmed: 16990192