Comparison of the Extracorporeal Treatments in Poisoning (EXTRIP) and
Paris Criteria for Lithium Poisoned Patients
Abstract
Aim: Two recommendations for hemodialysis in lithium poisoning, one from
the Extracorporeal TReatments in Poisoning (EXTRIP) workgroup and a
single center retrospective one (Paris), differ. We compared outcomes in
lithium poisoning based on these criteria with a primary outcome of
worsening neurological symptoms in patients where EXTRIP and Paris
criteria were discordant. Methods: Poison center data were queried for
lithium poisoned patients for whom hemodialysis was either recommended
or performed. Patients were categorized according to EXTRIP and Paris
criteria and excluded if the peak lithium concentration was
<1.2 mmol/L or if neurological follow-up was unavailable.
Comparative analyses were only performed when both criteria could be
assessed. Results: 219 patients were analyzed. Paris criteria were
applied in 70 and EXTRIP criteria in 178. 42 patients were excluded
because Paris criteria could not be applied. When Paris and EXTRIP both
supported hemodialysis, 50/57 (88%) of patients who received
hemodialysis improved, as did all 3 who did not receive hemodialysis.
When Paris and EXTRIP opposed hemodialysis, all non-dialyzed patients
did well. Among the 86 patients for whom EXTRIP supported hemodialysis
but Paris did not, 4/19 (21%) patients not dialyzed deteriorated
(p=0.02; OR=8.7, 95%CI=1.5-51.8), one of whom died. All 8 patients for
whom Paris criteria supported hemodialysis but EXTRIP did not were
dialyzed and improved. Conclusion: When the EXTRIP and Paris criteria
are discordant, EXTRIP criteria outperforms the Paris criteria at
identifying potentially ill patients who might benefit from
hemodialysis.