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Table 1 Clinical and laboratory parameters in 69 valproic acid-poisoned patients on admission to the intensive care unit and univariate comparisons according to L-carnitine administration

From: L-carnitine does not improve valproic acid poisoning management: a cohort study with toxicokinetics and concentration/effect relationships

  All patients
(n = 69)
Patients managed
without L-carnitine (n = 50)
Patients managed
with L-carnitine
(n = 19)
p-value
Demographics and medical history
Age (years) 41 [32–47] 40 [34–47] 40 [29–48] 0.70
Weight (kg) 69 [62–81] 68 [60–80] 68.0 [63–91] 0.96
Size (cm) 168 [162–173] 165 [160–170] 170 [160–174] 0.54
Body-mass index (kg/m2) 24.2 [21.3–29.2] 24 [31–22] 23 [19–26] 0.94
Gender (F/M), n (%) 40 (58%) / 29 (42%) 29 (58%) / 21 (42%) 11 (58%) / 8 (42%) 1.00
Mood disorder, n (%) 35 (51%) 29 (58%) 6 (32%) 0.063
Epilepsy, n (%) 29 (42%) 21 (42%) 8 (42%) 1.00
Psychotic disorder, n (%) 22 (32%) 14 (28%) 8 (42%) 0.39
Metabolic pathology, n (%) 8 (12%) 7 (14%) 1 (5%) 0.43
Heart disease, n (%) 6 (9%) 5 (10%) 1 (5%) 1.00
Liver disease, n (%) 4 (6%) 4 (8%) 0 (0%) 0.57
Diabetes mellitus, n (%) 2 (3%) 0 (0%) 2 (10%) 0.07
Chronic renal failure, n (%) 2 (3%) 2 (4%) 0 (0%) 1.00
Long-term VPA treatment, n (%) 49 (71%) 34 (68%) 15 (79%) 0.55
Sustained release VPA, n (%) 8 (14%) 3 (7%) 5 (33%) 0.026
Co-intoxications, n (%) 45 (74%) 33 (75%) 12 (71%) 0.75
Presumed dose ingested (g) 15.0 [10.0–32.0] 15.6 [10.0–31.0] 10.0 [3.0–30.0] 0.91
Clinical parameters on ICU admission
Glasgow coma score 6 [3–14] 6 [3–13] 8 [3–14] 0.24
Temperature (°C) 36.8 [32.2–37.3] 36.8 [36.2–37.5] 36.7 [36.1–37.2] 0.18
Systolic blood pressure (mmHg) 119 [110–133] 119 [110–133] 113 [101–130] 0.67
Diastolic blood pressure (mmHg) 64 [57–74] 64 [56–73] 66 [50–75] 0.035
Heart rate (/min) 94 [82–104] 93 [82–102] 95 [74–104] 0.11
Respiratory rate (/min) 19 [16–22] 19 [16–21] 20 [16–24] 0.48
Laboratory parameters on ICU admission
Serum creatinine (µmol/L) 73 [65–86] 74 [62–87] 70 [61–80] 0.39
Arterial pH 7.39 [7.36–7.43] 7.39 [7.36–7.43] 7.37 [7.36–7.44] 0.55
HCO3 (mmol/L) 23 [20–26] 23 [20–26] 22 [19–24] 0.003
PaO2/FiO2 (mmHg) 355 [262–467] 355 [281–470] 308 [105–450] 0.63
AST (IU/L) 27 [20–42] 25 [21–45] 24 [20–36] 0.43
ALT (IU/L) 19 [11–31] 19 [11–30] 17 [10–31] 0.84
Prothrombin index (%) 86 [77–94] 86 [78–94] 83 [72–91] 0.71
Bilirubin (UI/L) 7 [5–11] 6 [5–11] 7 [5–10] 0.17
White blood cells (G/L) 7.1 [5.4–9.3] 7.1 [5.4–9.4] 6.1 [4.8–8.5] 0.027
Platelets (G/L) 202 [168–251] 196 [163–251] 199 [184–234] 0.36
Hemoglobin (g/dL) 13.3 [12.2–14.4] 13 [12–14] 14 [12–16] 0.043
Blood lactate level (mmol/L) 2.9 [1.8–4.2] 2.7 [1.7–4.1] 3.3 [2.0–4.7] 0.001
Blood ammonia level (mmol/L) 96 [62–132] 83 [38–129] 96 [40–131] 0.30
Plasma VPA concentration (mg/L) 231 [147–415] 210 [143–358] 274 [174–607] 0.11
Physiological scores on ICU admission
SOFA score 4 [1–6] 4 [2–6] 5 [1–5] 0.59
SAPS II 32 [20–41] 30 [18–41] 35 [23–40] 0.35
Peak laboratory parameters
Peak blood lactate level (mmol/L) 3.7 [2.5–4.9] 3.5 [2.5–4.9] 4.6 [3.0–6.1] 0.002
Peak blood ammonia level (mmol/L) 127 [92–248] 124 [48–275] 227 [147–302] 0.19
Peak plasma VPA concentration (mg/L) 249 [150–398] 231 [147–365] 287 [174–779] 0.06
Complications in the ICU
Coma, n (%) 48 (70%) 30 (60%) 18 (95%) 0.007
Seizures, n (%) 2 (3%) 2 (4%) 0 (0%) 1.00
Agitation, n (%) 12 (17%) 9 (18%) 3 (18%) 1.00
Brain edema, n (%) 2 (3%) 0 (0%) 2 (11%) 0.073
Hypotension, n (%) 20 (29%) 14 (28%) 6 (32%) 0.77
Tachycardia, n (%) 20 (29%) 13 (26%) 7 (37%) 0.39
Cardiovascular failure, n (%) 14 (20%) 8 (14%) 6 (32%) 0.41
Lactic acidosis, n (%) 17 (36%) 12 (38%) 5 (33%) 0.31
Liver cytolysis, n (%) 6 (9%) 4 (8%) 2 (11%) 0.66
Thrombocytopenia, n (%) 15 (22%) 9 (18%) 6 (32%) 0.33
Anemia, n (%) 15 (22%) 8 (16%) 7 (37%) 0.099
Disseminated intravascular coagulation 2 (3%) 1 (2%) 1 (5%) 0.48
Acute kidney injury, n (%)     0.10
Stage 1 4 (6%) 2 (4%) 2 (11%)
Stage 2 7 (10%) 4 (8%) 3 (16%)
Stage 3 1 (2%) 0 (0%) 1 (5%)
Aspiration pneumonia, n (%) 23 (33%) 14 (28%) 9 (47%) 0.16
Hospital-acquired infection, n (%) 10 (15%) 6 (12%) 4 (21%) 0.45
Treatments in the ICU
Activated charcoal 32 (46%) 20 (40%) 12 (63%) 0.11
Ventilation
Non-invasive ventilation
Invasive ventilation
11 (16%)
41 (59%)
10 (20%)
25 (50%)
1 (5%)
16 (84%)
0.091
Norepinephrine, n (%) 13 (19%) 7 (14%) 6 (32%) 0.16
Sedation, n (%) 32 (46%) 22 (44%) 10 (53%) 0.59
Hemodialysis, n (%) 2 (3%) 0 (0%) 2 (11%) 0.073
Transfusion, n (%) 2 (3%) 1 (2%) 1 (5%) 0.48
Outcome, n (%)
Home
Medical ward
Psychiatry department
Death
29 (43%)
7 (10%)
29 (43%)
3 (4%)
22 (45%)
5 (10%)
21 (43%)
1 (2%)
7 (37%)
2 (11%)
8 (42%)
2 (11%)
0.49
Length of ICU stay (days) 3 [2–5] 2 [2–5] 5 [2–6] 0.06
  1. Significant p-values (< 0.05) are noted in bold
  2. ALT alanine aminotransferase, AST Aspartate aminotransferase, ICU intensive care unit, SAPS II Simplified Acute Physiology Score II, SOFA Sequential Organ Failure Assessment, VPA valproic acid. Acute kidney injury was staged based on KDIGO classification