Lung Derrick D, Kearney Thomas E, Brasiel James A, Olson Kent R
Department of Emergency Medicine, University of California, San Francisco, CA, USA California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA
California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA.
J Intensive Care Med. 2015 Jul;30(5):270-7. doi: 10.1177/0885066613516594. Epub 2013 Dec 26.
We assessed the predictive value of selected factors on the outcomes of death and prolonged renal insufficiency (RI) from ethylene glycol poisoning.
Retrospective, observational California Poison Control System study, over a 10-year period (1999-2008). We compared 2 groups. The first group (D/RI) included 59 patients who died (9 patients) or had prolonged RI (50 patients). Prolonged RI was defined as kidney injury in which dialysis was required for greater than 3 days after presentation. The second group (RECOV) of 62 patients had an uncomplicated recovery. Secondarily, we evaluated the association of time to antidote (ethanol and/or fomepizole) and time to dialysis with these outcomes.
The D/RI group was more likely than the RECOV group to present comatose, have seizures, and require intubation. The D/RI group had a lower mean initial arterial pH of 7.03 (standard deviation [SD] 0.20), compared to 7.27 (SD 0.14) for the RECOV group. The D/RI group had a higher initial creatinine (1.7 mg/dL, SD 0.71) than that of the RECOV group (1.0 mg/dL, SD 0.33). Patients with a time to antidote greater than 6 hours had a higher odds of dying or having prolonged RI (OR 3.34, 95% CI : 1.21-9.26) Patients with a time to dialysis greater than 6 hours had a lower odds of dying or having prolonged RI (OR 0.36, 95% CI : 0.15-0.87).
Compared to survivors with an uncomplicated recovery, patients poisoned with ethylene glycol who died or had prolonged RI were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Antidote administration within 6 hours is associated with better outcomes, unlike earlier time to dialysis.
我们评估了特定因素对乙二醇中毒所致死亡和持续性肾功能不全（RI）结局的预测价值。
一项回顾性观察性研究，基于加利福尼亚中毒控制系统，为期10年（1999 - 2008年）。我们比较了两组。第一组（死亡/持续性肾功能不全组，D/RI）包括59例死亡患者（9例）或发生持续性肾功能不全的患者（50例）。持续性肾功能不全定义为出现肾损伤且就诊后需要透析超过3天。第二组（康复组，RECOV）有62例患者康复过程未出现并发症。其次，我们评估了解毒剂使用时间（乙醇和/或甲吡唑）及透析时间与这些结局的关联。
与康复组相比，死亡/持续性肾功能不全组更易出现昏迷、癫痫发作且需要插管。死亡/持续性肾功能不全组的平均初始动脉血pH值较低，为7.03（标准差[SD]0.20），而康复组为7.27（SD 0.14）。死亡/持续性肾功能不全组的初始肌酐水平（1.7mg/dL，SD 0.71）高于康复组（1.0mg/dL，SD 0.33）。解毒剂使用时间超过6小时的患者死亡或发生持续性肾功能不全的几率更高（比值比[OR]3.34，95%置信区间[CI]：1.21 - 9.26）。透析时间超过6小时的患者死亡或发生持续性肾功能不全的几率较低（OR 0.36，95% CI：0.15 - 0.87）。
与康复过程未出现并发症的幸存者相比，死于乙二醇中毒或发生持续性肾功能不全的患者更易出现昏迷、癫痫发作和酸中毒等临床症状。与更早进行透析不同，6小时内给予解毒剂与更好的结局相关。
