Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication
Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication
复制标题
DOI：
10.3109/15563650.2011.639716
复制
发表时间：
2012-01-01
影响因子：
3.3
通讯作者：
Hwang, Seong Youn
中科院分区：
文献类型：
--
作者：
Lee, Younghwan;Lee, Jun Ho;Hwang, Seong Youn
上下文。血浆百草枯浓度被认为是急性百草枯中毒患者预后的最佳指标，但由于医疗资源有限，许多医院无法测量。相比之下，即使在当地医院，动脉乳酸也很容易获得。目标。评价急性百草枯中毒患者的初始动脉乳酸浓度是否能很好地预测死亡率。材料和方法。从2005年1月到2011年1月，三星昌原医院急诊科共收治了272名急性百草枯中毒患者。比较了幸存者和非幸存者在急诊科的初始动脉乳酸水平。通过分析受试者工作特征（ROC）曲线，比较初始动脉乳酸和急性生理与慢性健康评估II （APACHE II）评分系统。结果。总死亡率为81.6%；272名患者中有222人死亡。非幸存者动脉乳酸（8.30 +/- 4.04 mmol/L）高于幸存者（2.81 +/- 1.95 mmol/L） （p < 0.001）。多元logistic回归分析发现，动脉乳酸水平与死亡风险显著升高相关（优势比(OR) = 7.02, 95%可信区间= 2.06 -23.91,p = 0.002）。ROC曲线分析，动脉乳酸的面积为0.886，截止浓度为4.4 mmol/L（敏感性82%，特异性88%，最佳约登指数为0.7）。APACHEⅱ评分系统的面积为0.859，截断值为9（敏感性75%，特异性84%，最佳约登指数为0.59）。讨论与结论。动脉乳酸水平对评估急性百草枯中毒患者的预后有较好的预测作用。在医院没有检测血浆百草枯浓度的设施的情况下，测量动脉乳酸可能是评估百草枯中毒严重程度的一种简单实用的工具。
Context. Plasma paraquat concentration is recognized as the best prognostic indicator in patients with acute paraquat poisoning, but it cannot be measured in many hospitals due to limited medical resources. By contrast, arterial lactate is easily obtainable, even in local hospitals. Objective. To evaluate whether initial arterial lactate concentration is a good predictor of mortality in patients with acute paraquat poisoning. Materials and methods. A total of 272 patients with acute paraquat poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2005 to January 2011. Initial arterial lactate in the emergency department was compared in survivors and non-survivors. Initial arterial lactate and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score system were compared by analyzing receiver operating characteristic (ROC) curves. Results. The overall rate of mortality was calculated to be 81.6%; 222 out of 272 patients died. The arterial lactate was higher in non-survivors (8.30 +/- 4.04 mmol/L) than survivors (2.81 +/- 1.95 mmol/L) (p < 0.001). The arterial lactate was found to be associated with a significantly higher risk of death in a multiple logistic regression (odds ratio (OR) = 7.02, 95% confidence interval = 2.06 -23.91, p = 0.002). For the ROC curve analysis, the arterial lactate had an area of 0.886 and the cut-off concentration was 4.4 mmol/L (sensitivity 82%, specificity 88%, the best Youden index was 0.7). The APACHE II score system had an area of 0.859 and the cut off was 9 (sensitivity 75%, specificity 84%, and the best Youden index was 0.59). Discussion and conclusion. The arterial lactate had a good predictive power in evaluating the prognosis of patients with acute paraquat poisoning. In the case of hospitals without facilities to test plasma paraquat concentration, measurement of the arterial lactate may be a simple and practical tool for assessing the severity of paraquat poisoning.