Huang Neng-Chyan, Hung Yao-Min, Lin Shoa-Lin, Wann Shue-Ren, Hsu Chien-Wei, Ger Luo-Ping, Hung Shin-Yuan, Chung Hsiao-Min, Yeh Jeng-Hsien
Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
Clin Toxicol (Phila). 2006;44(2):99-102. doi: 10.1080/15563650500514251.
We have previously successfully applied the Acute Physiology and Chronic Health Evaluation (APACHE) II system to assess the severity of patients with acute paraquat poisoning, and this article investigates further evidence of the usefulness of APACHE II system in predicting the in-hospital mortality of 64 patients with acute paraquat poisoning over a period of 12 years. The predictive factors including APACHE II score, plasma paraquat concentration, severity index of paraquat poisoning (SIPP), and estimated ingestion dosage of paraquat for evaluating the outcome in paraquat-poisoned patients were assessed.
Overall mortality was 71.9%: 46 out of 64 patients died. Non-survivors (n = 46) had a higher APACHE II score (23.3 +/- 12.7) than survivors (n = 18) (6.1 +/- 4.2) (p < 0.001). The plasma paraquat concentration, SIPP, and estimated ingestion dosage of paraquat were significantly higher in non-survivors than in survivors (p < 0.05, in all comparisons). By multiple logistic regression analysis, only the APACHE II score and peak data of blood sugar in 24 h after admission were capable of predicting in-hospital mortality. By using the area under receiver operating characteristic curves (AURC), the APACHE II system yielded better discriminative power (AURC = 0.893) than SIPP (AURC = 0.674), plasma paraquat concentration (AURC = 0.676), and estimated ingestion dosage of paraquat (AURC = 0.673). An APACHE II score greater than 13 predicted in-hospital mortality with 67% sensitivity and 94% specificity.
The APACHE II score is a simple, reproducible, and practical tool for evaluating the severity of acute paraquat poisoning.
我们之前已成功应用急性生理学与慢性健康状况评价系统（APACHE）Ⅱ来评估急性百草枯中毒患者的病情严重程度，本文进一步研究APACHEⅡ系统在预测12年间64例急性百草枯中毒患者院内死亡率方面有效性的更多证据。评估了包括APACHEⅡ评分、血浆百草枯浓度、百草枯中毒严重指数（SIPP）以及估计的百草枯摄入量等预测因素，以评价百草枯中毒患者的预后。
总体死亡率为71.9%：64例患者中有46例死亡。非幸存者（n = 46）的APACHEⅡ评分（23.3±12.7）高于幸存者（n = 18）（6.1±4.2）（p<0.001）。非幸存者的血浆百草枯浓度、SIPP和估计的百草枯摄入量均显著高于幸存者（所有比较中p<0.05）。通过多因素逻辑回归分析，只有APACHEⅡ评分和入院后24小时血糖峰值数据能够预测院内死亡率。通过使用受试者工作特征曲线下面积（AURC），APACHEⅡ系统的鉴别能力（AURC = 0.893）优于SIPP（AURC = 0.674）、血浆百草枯浓度（AURC = 0.676）和估计的百草枯摄入量（AURC = 0.673）。APACHEⅡ评分大于13时预测院内死亡率的敏感度为67%，特异度为94%。
APACHEⅡ评分是评估急性百草枯中毒严重程度的一种简单、可重复且实用的工具。
