Prognostic Predictor of Acute Paraquat Intoxication Who Survived the Initial Injury

巴拉刈中毒的死亡率極高。中毒後初期的臨床因子如巴拉刈濃度，腎臟功能等被認為與病患預後有關。而對於急性期傷害存活病患之預後因子則尚未有定論。此研究的主要目的為分析巴拉刈中毒急性期傷害存活病患之預後因子。我們回顧性研究68位於本院治療的巴拉刈中毒病患。中毒病患的臨床因子如預後，血氧濃度，巴拉刈濃度，肝腎功能，血球計數，治療方式及時間記錄並分析。巴拉刈中毒病患死亡率為83.8%，死亡的病患中毒後初期尿液及血液的巴拉刈濃度高於存活病患(P=0.004, 0.001)。死亡的病患中毒後初期血液肌酸酐濃度高於存活病患(P=0.012)。其他中毒後初期的臨床因子如治療方式及時間，血氧濃度，白血球數等在兩組病患並無明顯差異。進一步分析發現臨床因子如肝腎功能，血球計數及血氧濃度於中毒後第三天達最高值。中毒後初期及中毒後第三天血液肌酸酐濃度與急性期傷害存活病患之死亡有相關性(P=0.039, 0.013)。ROC曲線分析發現以中毒後第三天血液肌酸酐濃度預測急性期傷害存活病患死亡之敏感性及專一性高於中毒後初期血液肌酸酐濃度。中毒後初期血液巴拉刈濃度亦與急性期傷害存活病患之死亡有相關性(P=0.043)。其他中毒後初期及中毒後第三天的臨床因子和治療方式及時間與急性期傷害存活病患之死亡並無相關性。總結以上，巴拉刈中毒病患中毒後初期尿液及血液的巴拉刈濃度越高死亡率越高。中毒後第三天血液肌酸酐濃度是巴拉刈中毒急性期傷害存活病患預後重要的預後因子。
Background: Paraquat intoxication has high mortality rate. Initial clinical parameters correlating with prognosis such as plasma and urine paraquat levels, serum creatinine levels and critical score were reported. It is still unknown what are the prognostic factors in patients who survived in initial injury. Aim: The aim of study was to define the late prognostic factors in patients who survived an initial multi-organ injury. Materials and Methods: Sixty-eight patients with paraquat poisoning admitted to our hospital from 1990 to 2005 were enrolled. The patients were further divided into survival and mortality groups according to the outcomes. The clinical courses including laboratory data, treatments and outcomes were reviewed retrospectively. Results: The overall mortality rate was 83.8%. The initial urine and plasma paraquat level of mortality patients were 44.90±12.58 ppm and 14.25±8.16 ppm respectively. The initial urine and plasma paraquat level of survival patients were 30.45±22.63 ppm and 0.85±1.26 ppm respectively. The initial urine and plasma paraquat levels of the mortality group were higher than the survival group. The creatinine level on the first day of survival and mortality patients were 0.84±0.26 mg/dl and 2.18±1.62 mg/dl respectively. Initial serum creatinine of the mortality group was higher significantly (P=0.012). The clinical parameters including arterial pressure of oxygen (PaO2), creatinine, alanine aminotransferase and total bilirubin reached the peak/lowest level in the third day after intoxication. The serum creatinine on the third day after poisoning of survival and late mortality patients were 1.28±0.46 mg/dl and 4.51±2.56 mg/dl. The serum creatinine at the third day after poisoning was significantly different between the survival and mortality patients who survived the first two days (P=0.013). No statistical difference in other clinical parameters and treatments was found between the survival and mortality groups. Conclusions: Initial high urine and plasma paraquat level was associated with high mortality. Serum creatinine on the third day after intoxication was the sole prognostic factor in our patients who survived the first two days.