title: Tumour lysis syndrome and acute kidney injury in high-risk haematology patients in the rasburicase era. A prospective multicentre study from the Groupe de Recherche en Réanimation Respiratoire et Onco-Hématologique.
abstract: In tumour lysis syndrome (TLS), metabolic alterations caused by the destruction of malignant cells manifest as laboratory abnormalities with (clinical TLS) or without (laboratory TLS) organ dysfunction. This prospective multicentre cohort study included 153 consecutive patients with malignancies at high risk for TLS (median age 54 years (interquartile range, 38-66). Underlying malignancies were acute leukaemia (58%), aggressive non-Hodgkin lymphoma (29.5%), and Burkitt leukaemia/lymphoma (12.5%). Laboratory TLS developed in 17 (11.1%) patients and clinical TLS with acute kidney injury (AKI) in 30 (19.6%) patients. After adjustment for confounders, admission phosphates level (odds ratio [OR] per mmol/l, 5.3; 95% confidence interval [95% CI], 1.5-18.3), lactic dehydrogenase (OR per x normal, 1.1; 95%CI, 1.005-1.25), and disseminated intravascular coagulation (OR, 4.1; 95%CI, 1.4-12.3) were associated with clinical TLS; and TLS was associated with day-90 mortality (OR, 2.45; 95%CI, 1.09-5.50; P = 0.03). In this study, TLS occurred in 30.7% of high-risk patients. One third of all patients experienced AKI, for which TLS was an independent risk factor. TLS was associated with increased mortality, indicating a need for interventional studies aimed at decreasing early TLS-related deaths in this setting.
authors.affiliation: Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France. michael.darmon@chu-st-etienne.fr
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Laurent
authors.initials: L
authors.lastname: Camous
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Caroline
authors.initials: C
authors.lastname: Bonmati
authors.forename: Thorsten
authors.initials: T
authors.lastname: Braun
authors.forename: Denis
authors.initials: D
authors.lastname: Caillot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Sophie
authors.initials: S
authors.lastname: Dimicoli
authors.forename: Anne
authors.initials: A
authors.lastname: Etienne
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Alice
authors.initials: A
authors.lastname: Garnier
authors.forename: Stéphane
authors.initials: S
authors.lastname: Girault
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault-Berger
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marolleau
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.forename: Christian
authors.initials: C
authors.lastname: Recher
authors.forename: Anne
authors.initials: A
authors.lastname: Thiebaud
authors.forename: Catherine
authors.initials: C
authors.lastname: Thieblemont
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage / Q000627:therapeutic use; D001639:Bicarbonates / Q000008:administration & dosage; D015415:Biomarkers; D015897:Comorbidity; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005440:Fluid Therapy; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012307:Risk Factors; D047368:Tumor Burden; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D014503:Urate Oxidase / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; C469709:rasburicase; D000493:Allopurinol; D014503:Urate Oxidase
keywords: acute kidney failure; haematologic malignancy; haemodialysis; hyperphosphataemia; intensive care units