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
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 |