Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

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Abstract

The present study investigated the predictive values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and Acute Physiology and Chronic Health Evaluation (APACHE) II score in the prognosis of patients with acute PQ poisoning. A total of 194 patients with acute PQ poisoning, hospitalized between April 2012 and January 2014 at the First Affiliated Hospital of P.R. China Medical University (Shenyang, China), were selected and divided into survival and mortality groups. Logistic regression analysis, receiver operator characteristic (ROC) curve analysis and Kaplan-Meier curve were applied to evaluate the values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and (APACHE) II score for predicting the prognosis of patients with acute PQ poisoning. Initial urine PQ concentration (C0), dose of poison, arterial blood lactate and APACHE II score of patients in the mortality group were significantly higher compared with the survival group (all P<0.05). Logistic regression analysis revealed that C0, dose of poison and arterial blood lactate correlated with mortality risk of acute PQ poisoning (all P<0.05). ROC curve analysis suggested that the areas under the curve (AUC) values of C0, dose of poison, arterial blood lactate and APACHE II score in predicting the mortality of patients within 28 days were 0.921, 0.887, 0.808 and 0.648, respectively. The AUC of C0 for predicting early and delayed mortality were 0.890 and 0.764, respectively. The AUC values of urine paraquat concentration the day after poisoning (Csec) and the rebound rate of urine paraquat concentration in predicting the mortality of patients within 28 days were 0.919 and 0.805, respectively. The 28-day survival rate of patients with C0 ≤32.2 µg/ml (42/71; 59.2%) was significantly higher when compared with patients with C0 >32.2 µg/ml (38/123; 30.9%). These results suggest that the initial urine PQ concentration may be the optimal index for predicting the prognosis of patients with acute PQ poisoning. Additionally, dose of poison, arterial blood lactate, Csec and rebound rate also have referential significance.

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Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.

Mark E Mikkelsen, Andrea N Miltiades, David F Gaieski … (2009)

Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension). To test whether the association between initial serum lactate level and mortality in patients presenting to the emergency department (ED) with severe sepsis is independent of organ dysfunction and shock. Single-center cohort study. The primary outcome was 28-day mortality and the risk factor variable was initial venous lactate (mmol/L), categorized as low ( or = 4). Potential covariates included age, sex, race, acute and chronic organ dysfunction, severity of illness, and initiation of early goal-directed therapy. Multivariable logistic regression analyses were stratified on the presence or absence of shock. The ED of an academic tertiary care center from 2005 to 2007. Eight hundred thirty adults admitted with severe sepsis in the ED. None. Mortality at 28 days was 22.9% and median serum lactate was 2.9 mmol/L. Intermediate (odds ratio [OR] = 2.05, p = 0.024) and high serum lactate levels (OR = 4.87, p < 0.001) were associated with mortality in the nonshock subgroup. In the shock subgroup, intermediate (OR = 3.27, p = 0.022) and high serum lactate levels (OR = 4.87, p = 0.001) were also associated with mortality. After adjusting for potential confounders, intermediate and high serum lactate levels remained significantly associated with mortality within shock and nonshock strata. Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.

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Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment.

R J Dinis-Oliveira, J Duarte, A. Sánchez-Navarro … (2008)

Paraquat dichloride (methyl viologen; PQ) is an effective and widely used herbicide that has a proven safety record when appropriately applied to eliminate weeds. However, over the last decades, there have been numerous fatalities, mainly caused by accidental or voluntary ingestion. PQ poisoning is an extremely frustrating condition to manage clinically, due to the elevated morbidity and mortality observed so far and due to the lack of effective treatments to be used in humans. PQ mainly accumulates in the lung (pulmonary concentrations can be 6 to 10 times higher than those in the plasma), where it is retained even when blood levels start to decrease. The pulmonary effects can be explained by the participation of the polyamine transport system abundantly expressed in the membrane of alveolar cells type I, II, and Clara cells. Further downstream at the toxicodynamic level, the main molecular mechanism of PQ toxicity is based on redox cycling and intracellular oxidative stress generation. With this review we aimed to collect and describe the most pertinent and significant findings published in established scientific publications since the discovery of PQ, focusing on the most recent developments related to PQ lung toxicity and their relevance to the treatment of human poisonings. Considerable space is also dedicated to techniques for prognosis prediction, since these could allow development of rigorous clinical protocols that may produce comparable data for the evaluation of proposed therapies.

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Occult hypoperfusion and mortality in patients with suspected infection.

Daniel Talmor, Michael W. Donnino, N. Shapiro … (2007)

To determine, in the early stages of suspected clinically significant infection, the independent relationship of the presenting venous lactate level to 28-day in-hospital mortality. Prospective, observational cohort study. Urban, university tertiary-care hospital. One thousand two hundred and eighty seven adults admitted through the emergency department who had clinically suspected infection and a lactate measurement. Seventy-three [5.7% (95% CI 4.4-6.9%)] patients died in the hospital within 28 days. Lactate level was strongly associated with 28-day in-hospital mortality in univariate analysis (p or=4.0 mmol/l had a mortality rate of 15.0% (6.0-24%). Patients with either septic shock or lactate >or=4.0 mmol/l had a mortality rate of 28.3% (21.3-35.3%), which was significantly higher than those who had neither [mortality of 2.5% (1.6-3.4%), p or=4.0 mmol/l had 7.1 (3.6-13.9) times the odds of death. The model had good discrimination (AUC=0.87) and was well calibrated. In patients admitted with clinically suspected infection, the venous lactate level predicts 28-day in-hospital mortality independent of blood pressure and adds significant prognostic information to that provided by other clinical predictors.

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Author and article information

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Journal ID (nlm-ta): Exp Ther Med

Journal ID (iso-abbrev): Exp Ther Med

Journal ID (publisher-id): ETM

Title: Experimental and Therapeutic Medicine

Publisher: D.A. Spandidos

ISSN (Print): 1792-0981

ISSN (Electronic): 1792-1015

Publication date (Print): July 2017

Publication date (Electronic): 17 May 2017

Publication date PMC-release: 17 May 2017

Volume: 14

Issue: 1

Pages: 79-86

Affiliations

[1 ]Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China

[2 ]Department of Biostatistics, School of Public Health, China Medical University, Shenyang, Liaoning 110001, P.R. China

Author notes

Correspondence to: Dr Zhi Liu, Department of Emergency, The First Affiliated Hospital of China Medical University, 155 Nanjing Street, Heping, Shenyang, Liaoning 110001, P.R. China, E-mail: cmu1h_lz@ 123456126.com

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Publisher ID: ETM-0-0-4463

DOI: 10.3892/etm.2017.4463

PMC ID: 5488431

PubMed ID: 28672896

SO-VID: dff36fdf-03e3-417b-8255-e6338fe73d53

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

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Most cited references 23

Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.

Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment.

Occult hypoperfusion and mortality in patients with suspected infection.

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