Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt.
Clinical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
Environ Sci Pollut Res Int. 2021 Aug;28(31):42161-42176. doi: 10.1007/s11356-021-13655-6. Epub 2021 Apr 2.
Dormex is widely used as a plant growth regulator in developing countries such as Egypt as well as worldwide. Despite the widespread use of Dormex, little is known about the exact mechanism of action and toxic profile. The current study aims to outline the factors that predict in-hospital outcome and the need for intensive care unit (ICU) admission among the patients who presented with acute hydrogen cyanamide exposure as well as to evaluate the roles of the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA) score as unfavorable outcome predictors. This is a retrospective cross-sectional study including all cases diagnosed with acute hydrogen cyanamide exposure who presented to the Tanta Poison Control Center during the past 6 years (January 1, 2015-January 1, 2020). Patient data were collected in a case report form, including the history of exposure, clinical data, laboratory investigations, and radiologic studies. Four scoring systems were carried out upon presentation: the Glasgow Coma Scale, poison severity score, MODS, and SOFA score. Thirty-five patients were enrolled in the current study. Most of the presented cases were males exposed unintentionally in an occupational setting. The mean participant age was 34.1 ± 15.51 years. The most common presenting complaints were throat irritation in all cases, vomiting and hallucinations presented equally in 68.6%, and headache occurred in 51.4%, whereas skin and mucous membrane burn was present in 40% of cases. Patients showing one or more of the following criteria were expected to have an urgent need for ICU admission: MODS >3.5, SOFA >4.5, length of hospital stay >30 hours, prothrombin time >14.75 seconds, serum glutamic pyruvic transaminase >67.5 U/L, and serum glutamic oxaloacetic transaminase >58.5 U/L. When the length of hospital stay was combined with the four scoring systems, only MODS yielded a significant prediction. Study results indicate that MODS and SOFA scores are considered excellent outcome predictors; MODS is more accurate, specific, and treatment independent, whereas the use of the SOFA score is more feasible with simple cardiovascular function assessment.
多效唑被广泛用作埃及等发展中国家和全球的植物生长调节剂。尽管多效唑被广泛使用,但对其确切的作用机制和毒性特征知之甚少。本研究旨在概述预测急性氢氰酸暴露患者住院结局和需要入住重症监护病房(ICU)的因素,并评估多器官功能障碍评分(MODS)和序贯器官衰竭评估(SOFA)评分作为不良结局预测因子的作用。这是一项回顾性的横断面研究,包括在过去 6 年(2015 年 1 月 1 日至 2020 年 1 月 1 日)期间在坦塔中毒控制中心就诊的所有诊断为急性氢氰酸暴露的患者。通过病例报告表收集患者数据,包括暴露史、临床数据、实验室检查和影像学研究。入院时进行了四项评分系统:格拉斯哥昏迷评分、中毒严重程度评分、MODS 和 SOFA 评分。本研究共纳入 35 例患者。大多数就诊患者为男性,在职业环境中意外暴露。患者平均年龄为 34.1±15.51 岁。最常见的临床表现为所有病例均有咽喉刺激,68.6%的病例同时出现呕吐和幻觉,51.4%的病例出现头痛,而 40%的病例出现皮肤和黏膜烧伤。预计以下一种或多种标准的患者需要紧急入住 ICU:MODS>3.5、SOFA>4.5、住院时间>30 小时、凝血酶原时间>14.75 秒、血清谷丙转氨酶>67.5 U/L 和血清谷草转氨酶>58.5 U/L。当住院时间与四项评分系统相结合时,只有 MODS 具有显著预测价值。研究结果表明,MODS 和 SOFA 评分被认为是优秀的预后预测因子;MODS 更准确、更特异、更独立于治疗,而 SOFA 评分的使用更可行,只需简单的心血管功能评估。