Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department
Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department
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DOI：
10.3109/15563650.2011.619137
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发表时间：
2011-11-01
影响因子：
3.3
通讯作者：
Chan, Chi Keung
中科院分区：
文献类型：
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作者：
Min, Young-Gi;Ahn, Jung Hwan;Chan, Chi Keung
objective.本研究的目的是验证和比较血清百草枯水平、百草枯中毒严重程度指数（SIPP）、急性生理学和慢性健康评价II的性能（APACHE II），改良简化急性生理学评分II（MSAPS II），和改良的扩展简化急性生理学评分II（MSAPS IIe）在到达急诊室（艾德）后立即计算，用于评估急性百草枯中毒的死亡率。方法.采用回顾性研究设计，主要结局指标为2001年至2010年的死亡率。采用MSAPS II和MSAPS IIe评估24小时尿量，不包括在内。比较了APACHE Ⅱ、MSAPS Ⅱ、MSAPS IIe、血清百草枯浓度和SIPP对急性百草枯中毒死亡率的预测能力。结果共有102例患者入组本研究。APACHE II的ROC曲线下面积（0.800）在统计学上低于MSAPS II、MSAPS IIe、SIPP和血清百草枯的ROC曲线下面积（分别为0.879、0.893、0.924和0.951）。Hosmer-Lemeshow拟合优度检验C统计量显示，APACHE II、MSAPS II、MSAPS IIe和血清百草枯水平具有良好的校准性（卡方8.477和p = 0.388，卡方4.614和p = 0.798，卡方5.301和p = 0.725，卡方1.009和p = 0.985），但SIPP的校准较差（卡方21.293和p = 0.006）。结论血清百草枯浓度仍是急性百草枯中毒最可靠的预后指标。但到达艾德后立即计算的MSAPS II或MSAPS IIe可能有助于预测急性百草枯中毒的死亡率，特别是当医院没有设备测量血清百草枯水平时。
Objective. The aim of this study was to validate and compare the performance of serum paraquat level, severity index of paraquat poisoning (SIPP), Acute Physiology And Chronic Health Evaluation II (APACHE II), modified Simplified Acute Physiology Score II (MSAPS II), and modified Expanded Simplified Acute Physiology Score II (MSAPS IIe) calculated immediately after arrival on emergency department (ED) for assessing the mortality of acute paraquat poisoning. Methods. A retrospective study design was employed with the main outcome measure being mortality from year 2001 to 2010. MSAPS II and MSAPS IIe were employed in that assessment of the 24-hour urine output were not included. The performance of APACHE II, MSAPS II, MSAPS IIe, serum paraquat level and SIPP for prediction of mortality in acute paraquat poisoning were compared. Results. A total of 102 patients were enrolled in the study. The area under the ROC curve for APACHE II (0.800) was statistically lower than those for MSAPS II, MSAPS IIe, SIPP and serum paraquat (0.879, 0.893, 0.924, and 0.951, respectively). The Hosmer-Lemeshow goodness-of-fit test C statistic revealed that APACHE II, MSAPS II, MSAPS IIe and serum paraquat level showed good calibrations (chi-square 8.477 and p = 0.388, chi-square 4.614 and p = 0.798, chi-squared 5.301 and p = 0.725, chi-squared 1.009 and p = 0.985 respectively), but poor calibration for SIPP (chi-square 21.293 and p = 0.006). Conclusion. Serum paraquat level is still the most reliable prognosis factor in acute paraquat poisoning. But MSAPS II or MSAPS IIe calculated immediately after arrival on ED may be helpful to predict mortality in acute paraquat poisoning especially when hospital has no facility to measure serum paraquat level.