Pajoumand Abdolkarim, Zamani Nasim, Hassanian-Moghaddam Hossein, Shadnia Shahin
Toxicological Research Center, Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
Int Urol Nephrol. 2017 Jun;49(6):1057-1062. doi: 10.1007/s11255-017-1521-2. Epub 2017 Feb 6.
We aimed to evaluate the efficacy of Lachance formula and more readily available clinical or laboratory factors (other than serum methanol level) in prediction of the needed time for hemodialysis in methanol-poisoned patients.
In a retrospective study, all methanol-poisoned patients referred to us between March 2008 and March 2016 were enrolled. The patients' demographic characteristics, on-arrival vital signs, signs/symptoms, and laboratory tests were evaluated for factors that could prognosticate the dialysis duration.
Of 72 patients enrolled, 54 underwent hemodialysis once (group 1) and 18 needed more than one session of hemodialysis (group 2). All were treated by ethanol, bicarbonate, and leucovorin. Lachance formula overestimated the patients in higher methanol levels and underestimated them in lower methanol levels. It properly predicted the needed time for hemodialysis when the methanol level was between 15 and 25 mg/dL. Groups 1 and 2 were different in terms of their ingested alcohol dose (P = 0.001), creatinine (P = 0.02), dyspnea on presentation (P = 0.002), and the place they had been dialyzed (P = 0.013). Dialysis duration significantly correlated with dyspnea on presentation (P = 0.028) and ingested alcohol dose (P = 0.02). After performance of logistic regression analysis, only creatinine was statistically significantly different between the two groups (P = 0.02). Median creatinine levels were 1.3 [1, 6] (0.8-2.7) and 1.4 [1.35, 2.1] (0.8-6.5) in the patients who were dialyzed once and twice, respectively.
As a conclusion, creatinine is possibly a readily available test that can predict the appropriate time needed for hemodialysis in methanol-poisoned patients.
我们旨在评估拉尚斯公式以及更易获得的临床或实验室因素（血清甲醇水平除外）在预测甲醇中毒患者所需血液透析时间方面的疗效。
在一项回顾性研究中，纳入了2008年3月至2016年3月期间转诊至我院的所有甲醇中毒患者。评估患者的人口统计学特征、入院时的生命体征、体征/症状以及实验室检查，以寻找能够预测透析持续时间的因素。
在纳入的72例患者中，54例接受了一次血液透析（第1组），18例需要不止一次血液透析（第2组）。所有患者均接受了乙醇、碳酸氢盐和亚叶酸治疗。拉尚斯公式在甲醇水平较高的患者中高估了所需透析时间，而在甲醇水平较低的患者中低估了所需透析时间。当甲醇水平在15至25mg/dL之间时，该公式能正确预测所需血液透析时间。第1组和第2组在摄入酒精剂量（P = 0.001）、肌酐（P = 0.02）、就诊时呼吸困难（P = 0.002）以及透析地点（P = 0.013）方面存在差异。透析持续时间与就诊时呼吸困难（P = 0.028）和摄入酒精剂量（P = 0.02）显著相关。进行逻辑回归分析后，两组之间仅肌酐存在统计学显著差异（P = 0.02）。接受一次和两次透析的患者的肌酐中位数分别为1.3 [1, 6]（0.8 - 2.7）和1.4 [1.35, 2.1]（0.8 - 6.5）。
总之，肌酐可能是一种易于获得的检查，可用于预测甲醇中毒患者所需的适当血液透析时间。
