TY - JOUR
T1 - Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning
AU - Chang, Meng Wei
AU - Chang, Shy Shin
AU - Chien-Chang, L. E.E.
AU - Sheu, Bor Fuh
AU - Young, Yui Rwei
PY - 2008/6
Y1 - 2008/6
N2 - Background: Clinical predictors associated with acute paraquat (PQ) poisoning have not been systematically studied. Objective: To identify independent predictors of death in patients with acute PQ poisoning. Methods: This is a retrospective study executed in the emergency department of a university hospital. One hundred three consecutive patients poisoned with PQ between January 1999 and December 2004 were enrolled. Urine PQ concentration, electrolyte and renal function, detailed history, and Acute Physiology and Chronic Health Evaluation II were extracted from medical records. The outcome measure was 30-day mortality. Multivariate analysis was done by Cox-proportional hazard regression model. Receiver operating characteristics area under the curve was calculated for selected predictors. Results: The crude 30-day mortality was 67.9% (70 of 103). Independent predictors of death were acute renal failure (hazard ratio, 3.53; 95% confidence interval, 1.97-6.32), hypokalemia (2.07, 1.21-3.51), hypothermia (2.91, 1.67-5.07), suicide (2.11, 1.04-4.29), and self-reported ingested dose (2.06, 1.38-3.06). The receiver operating characteristics area under the curve of serum potassium concentrations, maximal urine PQ concentrations, and Acute Physiology and Chronic Health Evaluation II scores were 0.75 (95% confidence interval, 0.60-0.81), 0.71 (0.66-0.84), and 0.80 (0.71-0.88), respectively. Under the cutoff value of 3.6 mEq/L, hypoka-lemia had a sensitivity of 75% and specificity of 54% in predicting mortality. Conclusion: The identified risk factors may allow better identification of those at greater mortality risk. Future development of a tailored clinical scoring system incorporating the identified risk factors for acute PQ poisoning may be of great help.
AB - Background: Clinical predictors associated with acute paraquat (PQ) poisoning have not been systematically studied. Objective: To identify independent predictors of death in patients with acute PQ poisoning. Methods: This is a retrospective study executed in the emergency department of a university hospital. One hundred three consecutive patients poisoned with PQ between January 1999 and December 2004 were enrolled. Urine PQ concentration, electrolyte and renal function, detailed history, and Acute Physiology and Chronic Health Evaluation II were extracted from medical records. The outcome measure was 30-day mortality. Multivariate analysis was done by Cox-proportional hazard regression model. Receiver operating characteristics area under the curve was calculated for selected predictors. Results: The crude 30-day mortality was 67.9% (70 of 103). Independent predictors of death were acute renal failure (hazard ratio, 3.53; 95% confidence interval, 1.97-6.32), hypokalemia (2.07, 1.21-3.51), hypothermia (2.91, 1.67-5.07), suicide (2.11, 1.04-4.29), and self-reported ingested dose (2.06, 1.38-3.06). The receiver operating characteristics area under the curve of serum potassium concentrations, maximal urine PQ concentrations, and Acute Physiology and Chronic Health Evaluation II scores were 0.75 (95% confidence interval, 0.60-0.81), 0.71 (0.66-0.84), and 0.80 (0.71-0.88), respectively. Under the cutoff value of 3.6 mEq/L, hypoka-lemia had a sensitivity of 75% and specificity of 54% in predicting mortality. Conclusion: The identified risk factors may allow better identification of those at greater mortality risk. Future development of a tailored clinical scoring system incorporating the identified risk factors for acute PQ poisoning may be of great help.
KW - Acute paraquat intoxication
KW - Hypokalemia
KW - Hypothermia
KW - Mortality
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U2 - 10.1097/MAJ.0b013e318157cb6d
DO - 10.1097/MAJ.0b013e318157cb6d
M3 - Article
C2 - 18552575
AN - SCOPUS:47749146475
SN - 0002-9629
VL - 335
SP - 451
EP - 456
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
IS - 6
ER -