Assessment of Acute Physiology and Chronic Health Evaluation, Modified Early Warning and Worthing Physiological Scores as Predictor for Mechanical Ventilation in Acute Organophosphorus Toxicity Patients

Abstract

Early assessment of patients presented with acute organophosphorus toxicity in the Emergency Department is an essential step to detect their pathway in the hospital. The present study aimed to assess the overall accuracy of Acute Physiology and Chronic Health Evaluation (APACHE II), Modifies Early Warning Score (MEWS), and Worthing Physiological Score (WPS) in predicting mechanical ventilation in acute organophosphorus toxicity patients. A cross-sectional cohort study was conducted on 132 patients presented with acute organophosphorus patients. From each patient, the following was collected: clinical data, routine laboratory investigations results, and blood samples for estimation of cholinesterase levels. The clinical and laboratory data were used to calculate APACHE II, MEWS, and WPS scores within six hours from admission. Statistical analysis revealed that the median values of APACHE II, MEWS, and WPS differed significantly between mechanically ventilated and non-mechanically ventilated patients. A strong significant negative correlation was detected between clinical severity and cholinesterase levels. WPS score showed the highest discriminatory power for predicting mechanical ventilation (area under the curve [AUC] 0.977). However, APACHE II and MEWS scores were nearly equal in their discriminatory power (AUC 0.924 and 0.927 respectively). Cholinesterase levels can be used as a useful diagnostic tool but are very poor in predicting patient outcomes (AUC 0.209 and 0.129 for acetylcholinesterase and butyrylcholinesterase respectively). In conclusion, using the WPS score for clinical evaluation of acute organophosphorus toxicity patients has valuable prognostic abilities for predicting patients' outcomes.