Acute Kidney Injury Predicts Mortality after Charcoal Burning Suicide.

Yu-Chin Chen,Hui-Ling Chen,Cheng-Hao Weng,Wey-Ran Lin,Tzung-Hai Yen,Shou-Hsuan Liu,Huang-Yu Yang,Yi-Chia Tseng,I-Kuan Wang,Ching-Wei Hsu,Kuan-Hsin Chen,Wen-Hung Huang,Jen-Fen Fu

doi:10.1038/srep29656

Abstract

A paucity of literature exists on risk factors for mortality in charcoal burning suicide. In this observational study, we analyzed the data of 126 patients with charcoal burning suicide that seen between 2002 and 2013. Patients were grouped according to status of renal damage as acute kidney injury (N = 49) or non-acute kidney injury (N = 77). It was found that patients with acute kidney injury suffered severer complications such as respiratory failure (P = 0.002), myocardial injury (P = 0.049), hepatic injury (P < 0.001), rhabdomyolysis (P = 0.045) and out-of-hospital cardiac arrest (P = 0.028) than patients without acute kidney injury. Moreover, patients with acute kidney injury suffered longer hospitalization duration (16.9 ± 18.3 versus 10.7 ± 10.9, P = 0.002) and had higher mortality rate (8.2% versus 0%, P = 0.011) than patients without injury. In a multivariate Cox regression model, it was demonstrated that serum creatinine level (P = 0.019) and heart rate (P = 0.022) were significant risk factors for mortality. Finally, Kaplan-Meier analysis revealed that patients with acute kidney injury suffered lower cumulative survival than without injury (P = 0.016). In summary, the overall mortality rate of charcoal burning suicide population was 3.2%, and acute kidney injury was a powerful predictor of mortality. Further studies are warranted.

Highlights

Charcoal burning suicide was firstly introduced by media to the crowd as a painless and peaceful suicide method in 1998, and soon overwhelmed several Asia countries[1]
The majorities of patients with acute kidney injury were male (81.6% versus 57.1%, P = 0.004) and had personal hobbies of smoking (59.2% versus 41.6%, P = 0.019) and alcohol consumption (49.0% versus 40.3%, P = 0.04) than patients without acute kidney injury
It was revealed that 46.0% of the charcoal burning suicide patients was single, 11.9% were divorced, 11.9% living alone, 42.1% senior high school educated, 31.7% were jobless, 21.4% had previous suicide history, 49.2% had depressive disorder, 39.7% had adjustment disorder, and 11.1% had substance abuse disorder (Table 2)

Summary

Introduction

Charcoal burning suicide was firstly introduced by media to the crowd as a painless and peaceful suicide method in 1998, and soon overwhelmed several Asia countries[1]. Acute kidney injury is a common and serious complication that is associated with high mortality rates in critically ill patients. An underlying feature of acute kidney injury is a rapid decline in glomerular filtration rate usually associated with decreases in renal blood flow. Charcoal burning was an important portion of suicide mortality and suicide rates for decades, and the scale of spreading and increasing of this method was huge. We hypothesized that there could be some physiological biomarkers such as acute kidney injury that may be associated with mortality after charcoal burning suicide. We sought to assess the association between acute kidney injury and mortality in patients after charcoal burning suicide

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