The Significance of Estimated Glomerular Filtration Rate for Predicting Mortality in Glyphosate Herbicide-Intoxicated Patients: A Single-Center, Retrospective Observational Study

Abstract

Background: Glyphosate herbicide (GH) is widely used worldwide. It has a higher fatality rate than expected. GH-poisoned cases are increasingly reported. Acute kidney injury in poisoned patients is one of several predictors of GH mortality. The aim of this study was to determine whether estimated glomerular filtration rate (eGFR) could predict kidney injury in GH intoxication. Methods: This was a retrospective study conducted at the emergency department (ED) of a single hospital between January 2004 and December 2021. A total of 434 patients presented with GH intoxication via oral ingestion, and 424 were enrolled. Their demographic characteristics, laboratory variables, complications, and mortality were analyzed to determine clinical predictors associated with GH-induced mortality using a logistic regression analysis. The relationship between GH intoxication and eGFR was determined based on the results of dominance analysis. Additionally, the comparison of creatinine and eGFR was performed through receiver operating characteristic (ROC) curves. Results: A total of 424 GH-poisoned patients were enrolled. Of them, 43 (10.1%) died. In the multivariable analysis, initial GCS (OR: 0.874; 95% CI: 0.765–0.998, p = 0.047), albumin (OR: 0.874; 95% CI: 0.765–0.998, p = 0.027), pH (OR: 0.002; 95% CI: 0.000–0.037, p < 0.001), QTc interval (OR: 1.018; 95% CI: 1.007–1.029, p = 0.001), and eGFR (OR: 0.969; 95% CI: 0.95–0.989, p = 0.003) were independent factors for predicting in-hospital mortality. In the dominance analysis of the relative importance of the predictive factors, pH accounted for the largest proportion at 35.8%, followed by QTc (20.0%), GCS (17.3%), eGFR (17.0%), and albumin (9.9%). Additionally, eGFR had a larger area under the ROC curve (0.846; 95% CI, 0.809–0.879) than that of creatinine (0.811; 95% CI, 0.771–0.848, p = 0.033). Conclusion: In sum, eGFR, considered a surrogate of renal function, was a useful prognostic factor for mortality in glyphosate herbicide-poisoned patients.