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Multicenter Study
. 2019 Dec 23;23(1):421.
doi: 10.1186/s13054-019-2706-0.

Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

François Dépret  1   2   3   4 , Clément Hoffmann  5 , Laura Daoud  1 , Camille Thieffry  6 , Laure Monplaisir  1 , Jules Creveaux  5 , Djillali Annane  7 , Erika Parmentier  6 , Daniel Mathieu  6 , Sandrine Wiramus  8 , Dominique Demeure DIt Latte  9 , Aubin Kpodji  10 , Julien Textoris  11 , Florian Robin  12 , Kada Klouche  13 , Emmanuel Pontis  14 , Guillaume Schnell  15 , François Barbier  16 , Jean-Michel Constantin  17 , Thomas Clavier  18   19 , Damien du Cheyron  20 , Nicolas Terzi  21 , Bertrand Sauneuf  22 , Emmanuel Guerot  23   24 , Thomas Lafon  25   26 , Alexandre Herbland  27 , Bruno Megarbane  28 , Thomas Leclerc  4 , Vincent Mallet  29 , Romain Pirracchio  30 , Matthieu Legrand  31   32   33   34   35
Affiliations
Multicenter Study

Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

François Dépret et al. Crit Care. .

Abstract

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: 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: 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: Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation.

Trial registration: ClinicalTrials.gov, NCT03558646.

Keywords: Acute kidney injury; Burn; Hydroxocobalamin; Intensive care unit; Mortality; Smoke inhalation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Non-adjusted and adjusted odds ratio (lower confidence interval, upper confidence interval) of hydroxocobalamin for AKI (upper panel) and severe AKI (lower panel). Adjusted on the following variables: age, peripheral arterial obstructive disease, diabetes mellitus, chronic hypertension, chronic kidney disease, prehospital cardiac arrest, severe burn, SOFA score without kidney item, vasopressors at admission, prehospital Glasgow coma scale, plasmatic lactate level at admission, maximum creatinine phosphokinase plasmatic level, contrast agent, use of vancomycin and aminoglycosides, and simplified acute physiology score 2
Fig. 2
Fig. 2
Unadjusted Kaplan–Meier curve of survival incidence during the 90 days following admission between patients who received hydroxocobalamin and those who did not
See this image and copyright information in PMC

References

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