External validation of the prognostic index in acute paraquat poisoning

Ds, Kim; Kang, Changwoo; Kim, Do-Hyung; Kim, SC; Sh, Lee; Jeong, J H; Kang, Tae-Ho; Jung, SM; Sb, Lee; Kw, Lee; Rb, Kim

doi:10.1177/0960327115586821

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…As reported in the literature, patients can develop esophageal mucosal casts, which can eliminate the esophageal lumen and cause obstructive symptoms. 2 Our clinical observation found that gastric lavage was not carried out in a timely and completely manner in almost transoral PQ poisoning patients with EDS, and in addition to different sizes and shapes of esophageal mucosal debris, esophageal mucosal desquamation mainly occurred within 3–8 days in patients with oral PQ poisoning, accompanied by a certain degree of bleeding. EDS can occur at any segment of upper gastrointestinal, such as pharyngeal, esophagus and even in fundus of stomach, more in esophagus, which means they come in many different shapes and length.…”

Section: Discussionmentioning

confidence: 79%

“…As reported in the literature, patients can develop esophageal mucosal casts, which can eliminate the esophageal lumen and cause obstructive symptoms. 2 Our clinical observation found that gastric lavage was not carried out in a timely and completely manner in almost transoral PQ poisoning patients with EDS, and in Note the formation of a row of tombstones-like basal cells that remain attached to the basement membrane (H&E, 3100). addition to different sizes and shapes of esophageal mucosal debris, esophageal mucosal desquamation mainly occurred within 3-8 days in patients with oral PQ poisoning, accompanied by a certain degree of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is not harmful to the environment due to its rapid deactivation after absorption in soil, however, PQ is highly toxic to humans when ingested. 2 PQ-exposure generates iNOS-mediated nitric oxide production, which causes lipid peroxidation and oxidative stress, finally leading to organ damage. 3 PQ also massively accumulates in lung epithelial cells and causes cellular damage by damaging the mitochondria directly and generating reactive oxygen species.…”

Section: Introductionmentioning

confidence: 99%

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Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases

Tao

Guo

et al. 2021

Science Progress

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To analyze the clinical characteristics and therapeutic effects of transoral paraquat poisoning combined with Esophagitis dissecans superficialis (EDS). A retrospective observational study was conducted on paraquat poisoning patients between January 1, 2011 and August 30, 2016 in Qilu hospital. Fifteen patients with EDS were enrolled in this study. The clinical characteristics, prognosis, and pathological features of esophageal necrosis mucosa of these patients were retrospectively analyzed and summarized. Esophageal mucosal dissection occurs mainly within 3–8 days after transoral paraquat poisoning in 15 patients. Dosage of paraquat is range from 50 to 100 ml. Most patients have physical problems with swallowing before the intramural esophageal dissection occurred. And there are other symptoms, including sore throat or dysphagia (100%), nausea and vomiting (86.7%), heartburn or upper abdominal pain (73.3%), hematemesis (60%), abdominal distension (20%) and cough frequently (6.7%). In death group, most patients demonstrate features of the multiple organ failure when the esophageal mucosal stripping happened, including lung injury, renal failure, and hepatic failure. The shape of esophageal dissection was tubular in 60%, irregular in 40%, and they vary in size. Pathological examination showed extensive injury, necrosis and hemorrhage of digestive tract epithelium, and obvious inflammatory reaction of epithelial tissue. Transoral paraquat poisoning has certain damage to the patient’s esophageal mucosa, and some may be complicated with EDS, and the prognosis is poor, especially when combined with multiple organ dysfunction. Esophageal damage is mainly located in the esophageal mucosa and have different degrees. Special attention should be paid on such patients.

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Section: Discussionmentioning

confidence: 79%

“…As reported in the literature, patients can develop esophageal mucosal casts, which can eliminate the esophageal lumen and cause obstructive symptoms. 2 Our clinical observation found that gastric lavage was not carried out in a timely and completely manner in almost transoral PQ poisoning patients with EDS, and in Note the formation of a row of tombstones-like basal cells that remain attached to the basement membrane (H&E, 3100). addition to different sizes and shapes of esophageal mucosal debris, esophageal mucosal desquamation mainly occurred within 3-8 days in patients with oral PQ poisoning, accompanied by a certain degree of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases

Tao

Guo

et al. 2021

Science Progress

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“…Given the unique characteristics of individual xenobiotics, many researchers have attempted to apply physiological scoring systems in patients with specific xenobiotic poisoning [7,8,[15][16][17][18]. Peter [7] compared the performance of APACHE-II, SAPS-II, and PSS in acute organophosphate poisoning.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department

et al. 2021

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Background A prediction model of mortality for patients with acute poisoning has to consider both poisoning-related characteristics and patients’ physiological conditions; moreover, it must be applicable to patients of all ages. This study aimed to develop a scoring system for predicting in-hospital mortality of patients with acute poisoning at the emergency department (ED). Methods This was a retrospective analysis of the Injury Surveillance Cohort generated by the Korea Center for Disease Control and Prevention (KCDC) during 2011–2018. We developed the new-Poisoning Mortality Scoring system (new-PMS) to generate a prediction model using the derivation group (2011–2017 KCDC cohort). Points were computed for categories of each variable. The sum of these points was the new-PMS. The validation group (2018 KCDC cohort) was subjected to external temporal validation. The performance of new-PMS in predicting mortality was evaluated using area under the receiver operating characteristic curve (AUROC) for both the groups. Results Of 57,326 poisoning cases, 42,568 were selected. Of these, 34,352 (80.7%) and 8216 (19.3%) were enrolled in the derivation and validation groups, respectively. The new-PMS was the sum of the points for each category of 10 predictors. The possible range of the new-PMS was 0–137 points. Hosmer–Lemeshow goodness-of-fit test showed adequate calibration for the new-PMS with p values of 0.093 and 0.768 in the derivation and validation groups, respectively. AUROCs of the new-PMS were 0.941 (95% CI 0.934–0.949, p < 0.001) and 0.946 (95% CI 0.929–0.964, p < 0.001) in the derivation and validation groups, respectively. The sensitivity, specificity, and accuracy of the new-PMS (cutoff value: 49 points) were 86.4%, 87.2%, and 87.2% and 85.9%, 89.5%, and 89.4% in the derivation and validation groups, respectively. Conclusions We developed a new-PMS system based on demographic, poisoning-related variables, and vital signs observed among patients at the ED. The new-PMS showed good performance for predicting in-hospital mortality in both the derivation and validation groups. The probability of death increased according to the increase in the new-PMS. The new-PMS accurately predicted the probability of death for patients with acute poisoning. This could contribute to clinical decision making for patients with acute poisoning at the ED.

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Hypokalemia is a biochemical signal of poor prognosis for acute paraquat poisoning within 4 hours

Liu

Wang

2016

Intern Emerg Med

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Anecdotal reports have suggested that hypokalemia is an independent predictor of mortality in patients with acute paraquat poisoning. However, the clinical significance of hypokalemia has not been systematically investigated in the early stage of paraquat poisoning. This study aimed to evaluate whether initial hypokalemia is a good predictor of mortality in patients with acute paraquat poisoning within 4 h. We retrospectively analyzed patients who were admitted to the emergency department after paraquat poisoning between September 2012 and January 2015. Demographic, clinical, and laboratory data were recorded, and the prognostic significance of hypokalemia was analyzed. A total of 120 patients were included. The 60-day mortality was 71.7 %. Serum potassium concentrations were significantly lower in non-survivors (3.1 ± 0.5 mmol/L) than in survivors (3.8 ± 0.3 mmol/L, P < 0.001). Independent predictors of death were amount of paraquat ingested (hazard ratio 1.005; 95 % confidence interval 1.002-1.007), serum potassium (0.498, 0.277-0.897), bicarbonate (0.934, 0.876-0.995), and white blood cell count (1.032, 1.001-1.065). For receiver operating characteristic curve analysis, serum potassium had an area under the curve of 0.852 (95 % confidence interval 0.784-0.920, P < 0.001), and the best cutoff value was 3.5 mmol/L (sensitivity, 88.2 %; specificity, 75.6 % in predicting survivors). Kaplan-Meier analysis showed that decreased serum potassium concentrations were associated with an increase in 60-day mortality (P < 0.001). Hypokalemia may be a reliable predictor in evaluating prognosis in paraquat poisoning within 4 h. The mechanism is not clear, and further studies verifying the precise mechanism of hypokalemia are required.

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External validation of the prognostic index in acute paraquat poisoning

Cited by 4 publications

References 14 publications

Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases

Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases

Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department

Hypokalemia is a biochemical signal of poor prognosis for acute paraquat poisoning within 4 hours

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