Association of extracorporeal therapy with persistent neurologic sequelae after lithium poisoning: A multicentre cohort study.

Aims

Lithium poisoning may result in persistent neurologic sequelae, including irreversible neurotoxicity. Although extracorporeal therapy enhances lithium elimination, its effect on clinically meaningful outcomes remains uncertain. We evaluated the association between extracorporeal therapy and persistent neurologic sequelae in patients with lithium poisoning.

Methods

We conducted a multicentre retrospective cohort study including 268 patients with lithium poisoning from four tertiary hospitals in Spain. The primary outcome was persistent neurologic sequelae for ≥2 months. Secondary outcomes included mortality, hospital length of stay and treatment-related complications. Multivariable logistic regression and propensity score weighting were used to adjust for differences in baseline severity and treatment indication.

Results

Among 268 patients, 108 (40.3%) received extracorporeal therapy. Patients receiving extracorporeal therapy had more severe poisoning, with higher peak lithium concentrations and more frequent acute kidney injury and neurologic manifestations. Persistent neurologic sequelae occurred in 55 patients (20.5%) and were less frequent among patients treated with extracorporeal therapy (11.1% vs. 26.9%; p = 0.002). In multivariable analysis, extracorporeal therapy was independently associated with lower odds of persistent neurologic sequelae (adjusted odds ratio 0.20, 95% CI 0.09-0.45). Higher peak lithium concentration and pre-existing neurologic disease were independently associated with persistent neurologic sequelae. Findings remained consistent after propensity score weighting. The association was strongest among patients meeting EXtracorporeal TReatments In Poisoning (EXTRIP)-recommended criteria.

Conclusions

Extracorporeal therapy was associated with a lower frequency of persistent neurologic sequelae in lithium poisoning, particularly among patients meeting EXTRIP Workgroup 'recommended' criteria. Prospective studies are needed to confirm these findings, particularly in intermediate-risk poisoning.