RESULTS
From over 2,000,000 cases in the database, 3541 lithium cases originated
from health care facilities, 347 had hemodialysis recommended or
performed, and 298 recorded both a supratherapeutic lithium
concentration and new neurological symptoms. Following exclusion for
incomplete data, 219 patients were analyzed.(Table 2) The Paris criteria
could be applied to 70 patients, while one or both EXTRIP criteria could
be applied to 178 patients (78 “recommended”; 146 “suggested”).
Forty-two patients were excluded from the comparison because data were
insufficient to determine whether Paris criteria could be applied.
Seventy patients met PARIS criteria for hemodialysis. (Table 3) Three
deteriorations (all of whom died) occurred among the 65 patients who had
hemodialysis. No deteriorations occurred in the 5 patients who did not
have hemodialysis. Statistical analysis was not performed because no
events occurred in one cell. One-hundred and seven patients did not meet
Paris criteria for hemodialysis. Deteriorations occurred in 2/83
patients (2.4%) dialyzed as opposed to 4/24 patients (16.6%) not
dialyzed (p=0.022) The odds ratio of deterioration for patients who did
not meet PARIS criteria for hemodialysis and were not dialyzed was 8.1
(95% CI 1.4-47.4).
Table 3 shows the data, analysis and comparisons for patients who met
the EXTRIP suggests criteria. As noted above, many statistical
comparisons were not possible because of zero events occurring in at
least one cell. Only two analyses reached statistical significance.
Among the 107 patients who did not meet the Paris criteria for
hemodialysis, 83 underwent the procedure. Neurological deterioration was
more likely in the remaining 24 patients who were not dialyzed (p =
0.22; OR 8.10(95% CI 1.39 - 47.39). For 81 patients outcomes could be
compared when EXTRIP criteria were met and PARIS criteria were not.
Clinical deterioration was more likely in these patients when they did
not undergo hemodialysis (p=0.01, OR 8.67 95% CI: 1.42 - 52.94). When
both criteria were met the majority of patients were dialyzed and there
were no deteriorations. Similarly, when both criteria were not met, the
majority of patients were dialyzed and there were no deteriorations.
Table 4 shows the data and analysis and comparisons for patients who met
the EXTRIP recommend criteria. As noted above, many comparisons were not
possible because of zero events occurring in at least one cell. The
comparison between EXTRIP recommends and PARIS did not reach statistical
significance.
There were 181 patients who met either the recommended or suggested
EXTRIP criteria for hemodialysis. Their analysis is summarized in table
5. Four of the 26 (15.4%) who did not have hemodialysis deteriorated
and one patient died as opposed to the 151 patients who underwent
hemodialysis among whom 5 deteriorated (3.3%) and 3 died (p=0.031). The
odd ratio for deterioration in the patients not dialyzed was 5.1 (95%
CI 1.3-20.3). In 41 patients EXTRIP neither recommended nor suggested
hemodialysis. All patients did well including 5/41 who did not receive
hemodialysis. Statistical analysis was not performed because no events
occurred in one cell. For 62 patients both the PARIS criteria and at
least one of the EXTRIP criteria for hemodialysis were met. The only
three deteriorations were among the 57 patients who underwent
hemodialysis. Statistical analysis was not performed because no events
occurred in one cell. There were 21 patients who fulfilled neither
criteria for hemodialysis. There were no deteriorations in this group,
including the five patients who did not receive hemodialysis.
Statistical analysis was not performed because no events occurred in one
cell. There were 86 patients who met at least one of the two EXTRIP
criteria for hemodialysis but did not meet the Paris criteria.
Hemodialysis was performed in 67 patients two of whom (3.0%)
deteriorated. In contrast, among patients not dialyzed 4/19 (21.1%)
deteriorated, one of whom died (p=0.019). The odd ratio for
deterioration if dialysis was not performed when EXTRIP was in favor of
hemodialysis and PARIS was not was 8.7 (95% CI 1.5-51.8). Table 6
provides a more detailed description of these four patients. Finally,
there were 8 patients for whom PARIS was in favor of hemodialysis but
neither of the two EXTRIP criteria were met. All 8 patients underwent
hemodialysis and there were no deteriorations. Statistical analysis was
not performed because no events occurred in one cell.