Cai Quan, Liu Zhi
Department of Emergency, the First Hospital of China Medical University, Shenyang 110001, Liaoning, China. Corresponding author: Liu Zhi, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Jun;26(6):379-82. doi: 10.3760/cma.j.issn.2095-4352.2014.06.003.
To determine the clinical indicators of early death (within 72 hours) in patients with acute paraquat poisoning.
The data of 93 acute paraquat poisoning patients admitted to emergency intensive care unit (EICU) of the First Hospital of China Medical University were retrospectively analyzed. The patients were divided into two groups according to whether they died within 72 hours or not. The gender, age, poison dose, paraquat concentration in urine, reduction of paraquat amount in urine after each hemoperfusion, and the worst value of white blood cell (WBC) count, lymphocytes count, arterial blood gas analysis, blood K⁺, Na⁺, Cl⁻, and serum amylase, serum lipase, serum total bilirubin, troponin I, creatine kinase (CK), blood urea nitrogen, serum creatinine within 24 hours after poisoning were compared. Spearman correlation analysis was used to analyze the correlation between paraquat concentration in urine and the dose of paraquat. The predictive value of each indicator at death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC curve).
Nineteen patients in the group of those died in early stage of poisoning (within 72 hours) resulted in a mortality rate of 20.4%. Compared with non-early death group, in early death group, the value of poison dose (133.4 ± 108.8 mL vs. 58.6 ± 40.0 mL, t=3.145, P=0.002), paraquat concentration in urine [16.34 (11.87, 96.76) mg/L vs. 4.46 (1.21, 12.78) mg/L, Z=-3.422, P=0.001], WBC (22.63 ± 9.72 × 10⁹/L vs. 14.95 ± 8.39 × 10⁹/L, t=3.446, P=0.001), blood lactate [Lac: 6.7 (2.2, 12.1) mmol/L vs. 1.9 (1.1, 3.4) mmol/L, Z=-3.294, P=0.001] were significantly higher, and the reduction rate of paraquat concentration in urine after first perfusion [(38.4 ± 15.63)% vs. (67.59 ± 27.87)%, t=2.945, P=0.004] and arterial partial pressure of carbon dioxide (PaCO₂: 28.7 ± 9.3 mmHg vs. 34.8 ± 6.7 mmHg, t=-3.245, P=0.002) were significantly lowered. There was no significant difference between two groups in other indexes. Poison dose and paraquat concentration in urine showed significantly positive correlation (r=0.450, P<0.001). ROC curve showed that the predictive value of paraquat concentration in urine, WBC, and Lac in early death were significant [area under the ROC curve (AUC) of paraquat concentrations in urine was 0.806, 95% confidence interval (95%CI) 0.699-0.913, the cut-off value was 11.64 mg/L, with sensitivity 84.6%, specificity 71.4%; AUC of WBC was 0.734, 95%CI 0.569-0.899, the cut-off value was 15.94×10(9)/L with sensitivity 69.2%, specificity 76.8%; AUC of Lac was 0.729, 95%CI 0.568-0.891, the cut-off value was 1.95 mmol/L with sensitivity 84.6%, specificity 42.9%].
Paraquat concentrations in urine, WBC, Lac, poison dose and PaCO2 were the risk factors of the early death of the acute paraquat poisoning. The research suggests that paraquat concentration in urine, WBC and Lac are valuable in predicting early death of the patients.
确定急性百草枯中毒患者早期死亡（72小时内）的临床指标。
回顾性分析中国医科大学附属第一医院急诊重症监护病房（EICU）收治的93例急性百草枯中毒患者的数据。根据患者是否在72小时内死亡将其分为两组。比较两组患者的性别、年龄、中毒剂量、尿百草枯浓度、每次血液灌流后尿百草枯量的减少情况，以及中毒后24小时内白细胞（WBC）计数、淋巴细胞计数、动脉血气分析、血钾、血钠、血氯，血清淀粉酶、血清脂肪酶、血清总胆红素、肌钙蛋白I、肌酸激酶（CK）、血尿素氮、血清肌酐的最差值。采用Spearman相关性分析尿百草枯浓度与百草枯剂量之间的相关性。用受试者工作特征曲线（ROC曲线）分析各指标在中毒早期死亡时的预测价值。
中毒早期死亡（72小时内）组19例患者，死亡率为20.4%。与非早期死亡组相比，早期死亡组中毒剂量（133.4±108.8 mL对58.6±40.0 mL，t=3.145，P=0.002）、尿百草枯浓度[16.34（11.87，96.76）mg/L对4.46（1.21，12.78）mg/L，Z=-3.422，P=0.001]、WBC（22.63±9.72×10⁹/L对14.95±8.39×10⁹/L，t=3.446，P=0.001）、血乳酸[Lac：6.7（2.2，12.1）mmol/L对1.9（1.1，3.4）mmol/L，Z=-3.294，P=0.001]显著更高，首次灌流后尿百草枯浓度降低率[（38.4±15.63）%对（67.59±27.87）%，t=2.945，P=0.004]和动脉血二氧化碳分压（PaCO₂：28.7±9.3 mmHg对34.8±6.7 mmHg，t=-3.245，P=0.002）显著降低。两组其他指标差异无统计学意义。中毒剂量与尿百草枯浓度呈显著正相关（r=0.450，P<0.001）。ROC曲线显示，尿百草枯浓度、WBC和Lac对早期死亡的预测价值显著[尿百草枯浓度的ROC曲线下面积（AUC）为0.806，95%置信区间（95%CI）0.699 - 0.913，截断值为11.64 mg/L，灵敏度84.6%，特异度71.4%；WBC的AUC为0.734，95%CI 0.569 - 0.899，截断值为15.94×10⁹/L，灵敏度69.2%，特异度76.8%；Lac的AUC为0.729，95%CI 0.568 - 0.891，截断值为1.95 mmol/L，灵敏度84.6%，特异度42.9%]。
尿百草枯浓度、WBC、Lac、中毒剂量和PaCO₂是急性百草枯中毒早期死亡的危险因素。研究提示，尿百草枯浓度、WBC和Lac对预测患者早期死亡有价值。
