Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning

Meng Wei Chang, Shy Shin Chang, L. E.E. Chien-Chang, Bor Fuh Sheu, Yui Rwei Young

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Clinical predictors associated with acute paraquat (PQ) poisoning have not been systematically studied. Objective: To identify independent predictors of death in patients with acute PQ poisoning. Methods: This is a retrospective study executed in the emergency department of a university hospital. One hundred three consecutive patients poisoned with PQ between January 1999 and December 2004 were enrolled. Urine PQ concentration, electrolyte and renal function, detailed history, and Acute Physiology and Chronic Health Evaluation II were extracted from medical records. The outcome measure was 30-day mortality. Multivariate analysis was done by Cox-proportional hazard regression model. Receiver operating characteristics area under the curve was calculated for selected predictors. Results: The crude 30-day mortality was 67.9% (70 of 103). Independent predictors of death were acute renal failure (hazard ratio, 3.53; 95% confidence interval, 1.97-6.32), hypokalemia (2.07, 1.21-3.51), hypothermia (2.91, 1.67-5.07), suicide (2.11, 1.04-4.29), and self-reported ingested dose (2.06, 1.38-3.06). The receiver operating characteristics area under the curve of serum potassium concentrations, maximal urine PQ concentrations, and Acute Physiology and Chronic Health Evaluation II scores were 0.75 (95% confidence interval, 0.60-0.81), 0.71 (0.66-0.84), and 0.80 (0.71-0.88), respectively. Under the cutoff value of 3.6 mEq/L, hypoka-lemia had a sensitivity of 75% and specificity of 54% in predicting mortality. Conclusion: The identified risk factors may allow better identification of those at greater mortality risk. Future development of a tailored clinical scoring system incorporating the identified risk factors for acute PQ poisoning may be of great help.

Original languageEnglish
Pages (from-to)451-456
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume335
Issue number6
DOIs
Publication statusPublished - Jan 1 2008
Externally publishedYes

Fingerprint

Paraquat
Hypokalemia
Hypothermia
Poisoning
Mortality
APACHE
ROC Curve
Area Under Curve
Urine
Confidence Intervals
Proportional Hazards Models
Acute Kidney Injury
Suicide
Electrolytes
Medical Records
Hospital Emergency Service
Potassium
Multivariate Analysis
Retrospective Studies
History

Keywords

  • Acute paraquat intoxication
  • Hypokalemia
  • Hypothermia
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning. / Chang, Meng Wei; Chang, Shy Shin; Chien-Chang, L. E.E.; Sheu, Bor Fuh; Young, Yui Rwei.

In: American Journal of the Medical Sciences, Vol. 335, No. 6, 01.01.2008, p. 451-456.

Research output: Contribution to journalArticle

Chang, Meng Wei ; Chang, Shy Shin ; Chien-Chang, L. E.E. ; Sheu, Bor Fuh ; Young, Yui Rwei. / Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning. In: American Journal of the Medical Sciences. 2008 ; Vol. 335, No. 6. pp. 451-456.
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T1 - Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning

AU - Chang, Meng Wei

AU - Chang, Shy Shin

AU - Chien-Chang, L. E.E.

AU - Sheu, Bor Fuh

AU - Young, Yui Rwei

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AB - Background: Clinical predictors associated with acute paraquat (PQ) poisoning have not been systematically studied. Objective: To identify independent predictors of death in patients with acute PQ poisoning. Methods: This is a retrospective study executed in the emergency department of a university hospital. One hundred three consecutive patients poisoned with PQ between January 1999 and December 2004 were enrolled. Urine PQ concentration, electrolyte and renal function, detailed history, and Acute Physiology and Chronic Health Evaluation II were extracted from medical records. The outcome measure was 30-day mortality. Multivariate analysis was done by Cox-proportional hazard regression model. Receiver operating characteristics area under the curve was calculated for selected predictors. Results: The crude 30-day mortality was 67.9% (70 of 103). Independent predictors of death were acute renal failure (hazard ratio, 3.53; 95% confidence interval, 1.97-6.32), hypokalemia (2.07, 1.21-3.51), hypothermia (2.91, 1.67-5.07), suicide (2.11, 1.04-4.29), and self-reported ingested dose (2.06, 1.38-3.06). The receiver operating characteristics area under the curve of serum potassium concentrations, maximal urine PQ concentrations, and Acute Physiology and Chronic Health Evaluation II scores were 0.75 (95% confidence interval, 0.60-0.81), 0.71 (0.66-0.84), and 0.80 (0.71-0.88), respectively. Under the cutoff value of 3.6 mEq/L, hypoka-lemia had a sensitivity of 75% and specificity of 54% in predicting mortality. Conclusion: The identified risk factors may allow better identification of those at greater mortality risk. Future development of a tailored clinical scoring system incorporating the identified risk factors for acute PQ poisoning may be of great help.

KW - Acute paraquat intoxication

KW - Hypokalemia

KW - Hypothermia

KW - Mortality

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