Impact of Acid-Base Status on Mortality in Patients with Acute Pesticide Poisoning

Abstract

We investigated clinical impacts of various acid-base approaches (physiologic, base excess (BE)-based, and physicochemical) on mortality in patients with acute pesticide intoxication and mutual intercorrelated effects using principal component analysis (PCA). This retrospective study included patients admitted from January 2015 to December 2019 because of pesticide intoxication. We compared parameters assessing the acid-base status between two groups, survivors and non-survivors. Associations between parameters and 30-days mortality were investigated. A total of 797 patients were analyzed. In non-survivors, pH, bicarbonate concentration (HCO3−), total concentration of carbon dioxide (tCO2), BE, and effective strong ion difference (SIDe) were lower and apparent strong ion difference (SIDa), strong ion gap (SIG), total concentration of weak acids, and corrected anion gap (corAG) were higher than in survivors. In the multivariable logistic analysis, BE, corAG, SIDa, and SIDe were associated with mortality. PCA identified four principal components related to mortality. SIDe, HCO3−, tCO2, BE, SIG, and corAG were loaded to principal component 1 (PC1), referred as total buffer bases to receive and handle generated acids. PC1 was an important factor in predicting mortality irrespective of the pesticide category. PC3, loaded mainly with pCO2, suggested respiratory components of the acid-base system. PC3 was associated with 30-days mortality, especially in organophosphate or carbamate poisoning. Our study showed that acid-base abnormalities were associated with mortality in patients with acute pesticide poisoning. We reduced these variables into four PCs, resembling the physicochemical approach, revealed that PCs representing total buffer bases and respiratory components played an important role in acute pesticide poisoning.

Prediction Model of Acute Respiratory Failure in Patients with Acute Pesticide Poisoning by Intentional Ingestion: Prediction of Respiratory Failure in Pesticide Intoxication (PREP) Scores in Cohort Study

“…In addition, in the present study, glufosinate ingestion was identified as an important risk factor for acute respiratory failure; the incidence rate of respiratory failure in glufosinate poisoning is the same as that of organophosphate and carbamate. Intriguingly, given the comparable incidence of respiratory failure, patients who were intoxicated with organophosphate and carbamate showed respiratory acidosis at emergency room, but this was not observed in glufosinate poisoning [4]. In this study, it was revealed that the development of respiratory failure in glufosinate poisoning was slightly delayed (6 h later) as compared to organophosphate and carbamate, therefore, respiratory failure was not captured at the emergency department in cases of glufosinate intoxication.…”

“…Pesticide poisoning is characterized by high mortality compared with other poisonings [23], but fatality of agricultural pesticides after self-poisoning pesticide poisoning depends on the class of pesticides [24]. There are some studies on mortality prediction in acute pesticide poisoning [3,4,25]. In common clinical situations, scoring systems for patients in intensive care unit have been developed and introduced during the last over 30 years [26,27].…”

“…While pesticides are characterized by various degrees of toxicity, high mortality is a common feature with all types of pesticide poisoning [1,2]. A majority of the deaths result from different complications including arrhythmia, hypotension, acid-base disturbance, and respiratory failure [3][4][5]. Among them, respiratory failure is the primary cause of mortality, although the clinical features of each pesticide poisoning case might be different depending on the chief ingredient of the pesticide ingested.…”

The Anion Gap and Mortality in Critically Ill Patients with Hip Fractures

“…Moreover, preoperative acidosis can be linked to coagulopathy [ 8 ]. It is depicted that acidosis is a potential cause of coagulopathy, and hemorrhage resulting from coagulopathy increases intraoperative mortality among patients with ruptured hip fractures [ 25 ]. Various levels of AG are substantially related to different incidence rates of coagulopathy, which could provide supportive evidence for this hypothesis.…”

Latent factors affecting safer injection practices that reduce infection and how education can improve them

“…A principal component analysis, one of the methods to reduce dimensionality, is performed to reduce and nd the principal components from many variables. We previously reported the principal components associated with death in patients using pesticide components [12]. Meanwhile, a factor analysis, which consists of exploratory factor analysis (EFA) and con rmatory factor analysis [13] is a well-known statistical method in the eld of psychology to extract latent variables, namely factors, from surveillance data [14].…”