Clinical context enhances interpretation of extracorporeal treatment criteria in lithium poisoning

ABSTRACT Background Lithium poisoning presents as acute, acute-on-chronic, or chronic exposure, phenotypes that differ in clinical expression and outcome. The Extracorporeal Treatments in Poisoning Workgroup criteria guide extracorporeal treatment, but whether their prognostic performance varies by poisoning type is uncertain. We assessed these criteria at initial evaluation and whether poisoning type improved risk stratification. Methods We conducted a retrospective multicenter cohort study of adult lithium-poisoning episodes between 2015 and 2022 in 26 tertiary hospitals in Spain, Ireland, and Switzerland. Poisoning was defined by compatible exposure plus serum lithium ≥ 1.5 mEq/L and classified as acute, acute-on-chronic, or chronic. The primary outcome was syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) at 60 days or in-hospital mortality. Sequential logistic-regression models evaluated any criterion, poisoning type, and age; discrimination used the area under the receiver-operating-characteristic curve (AUC). Results Among 644 episodes (136 acute, 196 acute-on-chronic, 312 chronic), the primary outcome occurred in 69 (11%). Any criterion was associated with the outcome after adjustment for poisoning type and age (odds ratio 1.94; 95% CI 1.10–3.44), as were acute-on-chronic poisoning (3.21; 1.27–8.11) and age (per year 1.05; 1.03–1.07). AUC rose from 0.61 to 0.72 with poisoning type and age added. In an exploratory model the clinical criterion remained associated with the outcome, whereas the analytical criterion did not. Conclusions Any Workgroup criterion was associated with adverse outcome. Discrimination improved when poisoning type and age were incorporated, and acute-on-chronic poisoning carried the highest adjusted risk. These findings support interpreting extracorporeal-treatment criteria within the clinical context rather than as serum lithium thresholds alone.

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Journal
Clinical Kidney Journal
Published
2026-09-24
DOI
https://doi.org/10.1093/ckj/sfag328
Primary Topic
Bipolar Disorder and Treatment
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article
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article

Clinical context enhances interpretation of extracorporeal treatment criteria in lithium poisoning

Jaime Laureiro Gonzalo, Neus Rodríguez Farré, Gregorio Rodríguez-Boto, Beatriz Martín-Pérez et al.
Clinical Kidney Journal
Bipolar Disorder and Treatment
article

Clinical context enhances interpretation of extracorporeal treatment criteria in lithium poisoning

Jaime Laureiro Gonzalo, Neus Rodríguez Farré, Gregorio Rodríguez-Boto, Beatriz Martín-Pérez, Santiago Nogué, August Supervía, Luca Cioccari, Antonio F Caballero-Bermejo, Jordi Puiguriguer-Ferrando, Héctor Hernández Ontiveros, Xavier Canseco Suárez, Alberto Cózar-Llistó, Ana Ramos Rodríguez, Mikel Urroz, Isabel Llopis Sanmillan, B Ruiz-Antorán, Francisca Córdoba, Blanca Andrea Gallardo Sánchez, Guillermo Burillo-Putze, Natalia Sanz-López, Edith Gutierrez, Marina Vergara Ortiz, Pablo Navarro Román, Álvaro Pineda-Torcuato, Carolina Sánchez, Susanna Vert García, María del Pilar Gómez Jiménez, Victoria Lobo-Antuña, Francisco J Callado Moro, Paula Romero Gallardo, Emilio Salgado, Cormack Kennedy, Sandra Mora Azabal, Macarena Lucila Míguez del Águila, Andrea Terron Sánchez, Ruadhan O´Laoi, Benjamín Climent, Valle Molina Samper, M Àngels Gispert-Ametller
article en

Abstract

ABSTRACT Background Lithium poisoning presents as acute, acute-on-chronic, or chronic exposure, phenotypes that differ in clinical expression and outcome. The Extracorporeal Treatments in Poisoning Workgroup criteria guide extracorporeal treatment, but whether their prognostic performance varies by poisoning type is uncertain. We assessed these criteria at initial evaluation and whether poisoning type improved risk stratification. Methods We conducted a retrospective multicenter cohort study of adult lithium-poisoning episodes between 2015 and 2022 in 26 tertiary hospitals in Spain, Ireland, and Switzerland. Poisoning was defined by compatible exposure plus serum lithium ≥ 1.5 mEq/L and classified as acute, acute-on-chronic, or chronic. The primary outcome was syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) at 60 days or in-hospital mortality. Sequential logistic-regression models evaluated any criterion, poisoning type, and age; discrimination used the area under the receiver-operating-characteristic curve (AUC). Results Among 644 episodes (136 acute, 196 acute-on-chronic, 312 chronic), the primary outcome occurred in 69 (11%). Any criterion was associated with the outcome after adjustment for poisoning type and age (odds ratio 1.94; 95% CI 1.10–3.44), as were acute-on-chronic poisoning (3.21; 1.27–8.11) and age (per year 1.05; 1.03–1.07). AUC rose from 0.61 to 0.72 with poisoning type and age added. In an exploratory model the clinical criterion remained associated with the outcome, whereas the analytical criterion did not. Conclusions Any Workgroup criterion was associated with adverse outcome. Discrimination improved when poisoning type and age were incorporated, and acute-on-chronic poisoning carried the highest adjusted risk. These findings support interpreting extracorporeal-treatment criteria within the clinical context rather than as serum lithium thresholds alone.

Clinical Kidney Journal
Universidad de La Laguna (ES), Universitat Pompeu Fabra (ES), Trinity College (CA), Trinity College Dublin (IE), Hospital Universitario de Canarias (ES), Hospital Universitario La Paz (ES), University Hospital of Bern (CH), Hospital de Sant Pau (ES), University Hospital Complex Of Vigo (ES), Universidad Nebrija (ES), Hospital Universitario de Torrejón (ES), Hospital de Viladecans (ES), Hospital Universitario 12 De Octubre (ES), Hospital Universitario de Getafe (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Sociedad Española de Medicina de Familia y Comunitaria (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario de Burgos (ES), Navarrabiomed (ES), Hospital General Universitario De Valencia (ES), Hospital Juan Ramón Jiménez (ES), Hospital Del Mar (ES), Hospital de Sant Joan Despí Moisès Broggi (ES), Parc de Salut (ES), Hospital Universitario Son Espases (ES), St. James's Hospital (IE), Hospital Universitari de Girona Doctor Josep Trueta (ES), Hospital Universitario Río Hortega (ES), Hospital Universitario Severo Ochoa (ES), Kantonsspital Aarau (CH), Hospital Universitario Ramón y Cajal (ES), Universidad Autónoma de Madrid (ES), Universitat de Barcelona (ES)
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Bipolar Disorder and Treatment
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