The reason for this lies in the parallel arrangement of arterial and venous pre-glomerular and post-glomerular vessels, which allow oxygen to pass from arterioles into the postcapillary venous system via shunt diffusion. Despite high blood flow and oxygen delivery, oxygen tensions in the kidney are comparatively low, in particular in the renal medulla. The kidney shows a remarkable discrepancy between blood supply and oxygenation 9. Inflammation represents an important additional component of acute kidney injury leading to the extension phase of renal injury 6. An underlying feature of acute kidney injury is a rapid decline in glomerular filtration rate usually associated with decreases in renal blood flow. The carbon monoxide is a colorless, odorless, nonirritant gas that accounts for numerous cases of carbon monoxide poisoning every year from a variety of sources of incomplete combustion of hydrocarbons such as indoor burning of charcoal burning briquettes 8. Carbon monoxide toxicity is the result of a combination of tissue hypoxia-ischemia secondary to carboxyhemoglobin formation and direct carbon monoxide-mediated damage at a cellular level 7. The primary causes of acute kidney injury include ischemia, hypoxia, or nephrotoxicity 6. Moreover, suicide by gases (mainly charcoal-burning) also showed a marked increase in suicide mortality data recently, which caused 6,822 deaths during the period form 1999–2007 in Taiwan 3 and had become a severe public health problem 5.Īcute kidney injury is a common and serious complication that is associated with high mortality rates in critically ill patients. That made an increase of 39% suicide rates during 1998–2002 in urban Taiwan 4. In addition, Taiwan showed the largest magnitude of increase during 1995/1996–2011, about 65-fold increase in rate in affected Asian countries 1. The increase of charcoal-burning suicide influenced mainly in urban areas than rural areas and metropolitan regions had the highest rate 3. The rise of charcoal-burning suicide in Taiwan started at 2000 1 and the method soon occupied 10 out of 22 cities/counties in 2006 as the leading suicide method 2. It was proposed that widespread media coverage of this apparent painless suicide method and easy access to barbecue charcoal may have contributed to the epidemic in Asia countries 3. Media reports of charcoal-burning suicide played a role in spreading the idea and there was an increase of charcoal-burning suicide incidence 2, 3. In the East/Southeast areas, charcoal-burning suicide significantly increased in Taiwan, Hong Kong, Japan, Korea and Singapore, but not in Malaysia, Philippines and Thailand. Further studies are warranted.Ĭharcoal burning suicide was firstly introduced by media to the crowd as a painless and peaceful suicide method in 1998 and soon overwhelmed several Asia countries 1. In summary, the overall mortality rate of charcoal burning suicide population was 3.2% and acute kidney injury was a powerful predictor of mortality. Finally, Kaplan-Meier analysis revealed that patients with acute kidney injury suffered lower cumulative survival than without injury (P = 0.016). In a multivariate Cox regression model, it was demonstrated that serum creatinine level (P = 0.019) and heart rate (P = 0.022) were significant risk factors for mortality. Moreover, patients with acute kidney injury suffered longer hospitalization duration (16.9 ± 18.3 versus 10.7 ± 10.9, P = 0.002) and had higher mortality rate (8.2% versus 0%, P = 0.011) than patients without injury. It was found that patients with acute kidney injury suffered severer complications such as respiratory failure (P = 0.002), myocardial injury (P = 0.049), hepatic injury (P < 0.001), rhabdomyolysis (P = 0.045) and out-of-hospital cardiac arrest (P = 0.028) than patients without acute kidney injury. Patients were grouped according to status of renal damage as acute kidney injury (N = 49) or non-acute kidney injury (N = 77). In this observational study, we analyzed the data of 126 patients with charcoal burning suicide that seen between 20. A paucity of literature exists on risk factors for mortality in charcoal burning suicide.
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