Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
Basic Clin Pharmacol Toxicol. 2018 Nov;123(5):615-621. doi: 10.1111/bcpt.13044. Epub 2018 Sep 11.
This study aimed to investigate whether the quick Sequential Organ Failure Assessment (qSOFA) score at emergency department (ED) presentation can help improve the risk assessment of glyphosate-surfactant herbicide (GlySH) poisoning complications. A total of 150 patients presenting with acute glyphosate herbicide ingestion were enrolled in this retrospective observational study. The qSOFA scores at presentation, ΔqSOFA (calculated by subtracting the worst qSOFA score from 1 hr after admission from the qSOFA score at presentation), baseline characteristics, clinical courses and outcome were collected and analysed. A total of 41 patients had life-threatening complications (27.3%), and 14 patients died (9.3%). Patients with a qSOFA score of 0 at presentation had a 1.5% incidence rate of complications. As the qSOFA score at presentation increased from 1 to 3, the rate of life-threatening complications significantly increased from 29.6% to 100%. Patients with a ΔqSOFA of 1 had a higher frequency of complications than did patients with a ΔqSOFA of 0. The qSOFA score (OR: 8.39, 95% CI: 3.51-26.67) and ΔqSOFA (OR: 27.60, 95% CI: 3.87-575.67) were associated with the development of life-threatening complications in the multivariate analysis. The qSOFA score showed high sensitivity (97.56%), and the ΔqSOFA score showed high specificity (99.08%). The values of area under the curve were significantly higher in the models using the qSOFA and ΔqSOFA than they were in the models using previously known prognostic factors (p < 0.01). The clinician should pay more attention to patients with high qSOFA scores at presentation or an increase in the qSOFA score 1 hr after admission.
本研究旨在探讨急诊就诊时快速序贯器官衰竭评估（qSOFA）评分是否有助于改善草甘膦表面活性剂除草剂（GlySH）中毒并发症的风险评估。本回顾性观察研究共纳入 150 例急性草甘膦除草剂摄入患者。收集并分析了就诊时的 qSOFA 评分、ΔqSOFA（就诊时 qSOFA 评分减去入院后 1 小时最差 qSOFA 评分）、基线特征、临床过程和结局。共有 41 例患者发生危及生命的并发症（27.3%），14 例患者死亡（9.3%）。就诊时 qSOFA 评分为 0 的患者并发症发生率为 1.5%。随着就诊时 qSOFA 评分从 1 增加到 3，危及生命的并发症发生率从 29.6%显著增加到 100%。ΔqSOFA 为 1 的患者并发症发生率高于ΔqSOFA 为 0 的患者。多变量分析显示，qSOFA 评分（OR：8.39，95%CI：3.51-26.67）和ΔqSOFA（OR：27.60，95%CI：3.87-575.67）与危及生命的并发症的发生相关。qSOFA 评分具有高灵敏度（97.56%），ΔqSOFA 评分具有高特异性（99.08%）。与使用先前已知预后因素的模型相比，使用 qSOFA 和 ΔqSOFA 的模型的曲线下面积值显著更高（p<0.01）。临床医生应更加关注就诊时 qSOFA 评分较高或入院后 1 小时 qSOFA 评分增加的患者。
