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

François Dépret,François Barbier,Nicolas Terzi,Clément Hoffmann,Laura Daoud,Camille Thieffry,Bertrand Sauneuf,Vincent Mallet,Florian Robin,Daniel Mathieu,Bruno Mégarbane ,Emmanuel Guérot ,Julien Textoris,Dominique Demeure Dit Latte,Romain Pirracchio,Thomas Leclerc,Laure Monplaisir,Emmanuel Pontis,Erika Parmentier,Jean-Michel Constantin,Kada Klouche,Damien Du Cheyron,Thomas Lafon,Alexandre Herbland,Jules Creveaux,A Kpodji ,Djillali Annane,Thomas Clavier,Guillaume Schnell,Sandrine Wiramus,Matthieu Legrand

doi:10.1186/s13054-019-2706-0

Abstract

BackgroundThe 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.MethodsWe 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.ResultsAmong 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.ConclusionHydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation.Trial registrationClinicalTrials.gov, NCT03558646

Highlights

Patients with smoke inhalation are at a high risk of death or major morbidities
The use of hydroxocobalamin was associated with acute kidney injury (AKI), severe AKI, and renal replacement therapy (RRT) (Table 1)
After adjusting for potential confounders, hydroxocobalamin remained associated with AKI and severe AKI and RRT (Table 2, Fig. 1 and Additional file 3: Table S3)

Summary

Introduction

Cyanide is a documented cause for rapid death after intoxication from smoke [1]. Several experts suggested using hydroxocobalamin as the first-line treatment after suspected cyanide intoxication due to its perceived good safety profile [3]. Other experts raised concerns about liberalizing the use of hydroxocobalamin after smoke inhalation due to a lack of data on both efficacy and tolerance. They have called for additional investigations [4, 5]. The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored

Methods

Results

Conclusion