Kaplan-Meier survival assessment of the patients with opioid drug poisoning complicated by acute kidney damage

Abstract

RESUME. Despite the fact that opioids do not have direct nephrotoxicity, a significant overdose, or their combination with alcohol and other psychotropic substances, contributes to the development of critical changes in many organs and systems of the body, which leads, in particular, to acute kidney injury (AKI). Aim. Using comparative analysis and the Kaplan-Meier method, to investigate the survival rates of patients with opioid drug poisoning complicated by acute respiratory distress syndrome treated with hemodialysis. Materials and Methods. A cohort retrospective analysis of the medical data of 128 patients (107 men, 21 women) aged 18 to 39 years who received treatment in the intensive care and extracorporeal detoxification department of the "Kyiv City Emergency Hospital" in the period 2017–2021 with a diagnosis of "Acute drug poisoning" (МКХ-10:Т40.0-Т40.3), complicated by the development of acute renal failure. Statistical analysis of the study results was performed using the Kaplan-Meier survival estimate; p≤0.05; the statistical analysis application package from Microsoft Excel 2019 was used. Results. Kaplan-Meier graphs indicated that patients with AKI due to morphine, heroin, and methadone poisoning have a statistically significant difference in survival rates (p < 0.05). The highest survival rates were shown by patients with morphine poisoning (100 %), the lowest were in groups with methadone (82.7 %) and heroin poisoning (48.3 %). Kaplan-Meier curves showed that all deaths occurred within 3–18 days of starting treatment, with most deaths (90 %) occurring within 3–12 days. Cumulative survival rates among patients with methadone-induced AKI stratified by blood alcohol content showed that among patients with methadone poisoning where alcohol was not detected, the survival rate was 100 %, and among patients with combined methadone and alcohol poisoning it was 75.2 %. Conclusions. Despite the similarity of the clinical picture in poisoning with natural and synthetic opioids (opioid syndrome), the causes of development of AKI and its course differ in patients with poisoning by different groups of drugs. Survival rates among patients with methadone poisoning are adversely affected by the presence of alcohol in the blood. Key Words: combined drug poisoning, renal failure.