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急性甲醇中毒的结局评估:一种用于预测院内死亡率的风险预测列线图方法。

Outcome assessment of acute methanol poisoning: A risk-prediction nomogram approach for in-hospital mortality.

作者信息

Abdelhamid Walaa G, El-Sarnagawy Ghada N, Sobh Zahraa Khalifa

机构信息

Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Toxicol Rep. 2024 Nov 14;13:101817. doi: 10.1016/j.toxrep.2024.101817. eCollection 2024 Dec.

Abstract

Acute methanol poisoning could be associated with high morbidities and fatalities. Stratifying high-risk patients is crucial in improving their prognosis. Hence, this study aimed to identify patients with methanol poisoning at high risk of in-hospital mortality. Also, the risk factors for blindness were assessed. The study included 180 acutely methanol-poisoned patients who received standard medical care. Out of 180 patients, 52 (28.9 %) patients presented with blindness, and 43 (23.9 %) patients died. The predictive model was based on four significant variables, including blindness, mean arterial pressure, serum bicarbonate, and serum creatinine. The presence of blindness and elevated serum creatinine significantly increased the likelihood of mortality by 14.274 and 5.670 times, respectively. Likewise, decreases in mean arterial pressure and serum bicarbonate significantly increased mortality risk by 0.908 and 0.407 times, respectively. The proposed nomogram exhibited excellent discriminatory power (area under the curve (AUC)=0.978, accuracy=93.3 %), which outperforms the AUCs of individual predictors. The provided nomogram is easily applicable with outstanding discrimination, making it clinically helpful in predicting in-hospital mortality in acutely methanol-poisoned patients. Regarding the risk factors for blindness, multivariable regression analysis revealed that delayed time for admission (OR=1.039; 95 % CI=1.010-1.069; = 0.009) and elevated anion gap (OR=1.053; 95 % CI=1.007-1.101; = 0.023) were significant risk factors. The current study assists physicians in identifying methanol-poisoned patients with a high probability of mortality or blindness on admission. Future studies are recommended for external validation of the created nomogram, in addition to follow-up for patients with visual impairment.

摘要

急性甲醇中毒可能导致高发病率和死亡率。对高危患者进行分层对于改善其预后至关重要。因此,本研究旨在识别住院死亡率高风险的甲醇中毒患者。此外,还评估了失明的危险因素。该研究纳入了180例接受标准医疗护理的急性甲醇中毒患者。在180例患者中,52例(28.9%)出现失明,43例(23.9%)死亡。预测模型基于四个显著变量,包括失明、平均动脉压、血清碳酸氢盐和血清肌酐。失明和血清肌酐升高分别使死亡可能性显著增加14.274倍和5.670倍。同样,平均动脉压和血清碳酸氢盐降低分别使死亡风险显著增加0.908倍和0.407倍。所提出的列线图具有出色的区分能力(曲线下面积(AUC)=0.978,准确率=93.3%),优于单个预测指标的AUC。所提供的列线图易于应用且具有出色的区分度,在预测急性甲醇中毒患者的住院死亡率方面具有临床帮助。关于失明的危险因素,多变量回归分析显示,入院延迟时间(OR=1.039;95%CI=1.010 - 1.069;P = 0.009)和阴离子间隙升高(OR=1.053;95%CI=1.007 - 1.101;P = 0.023)是显著的危险因素。本研究有助于医生在入院时识别死亡率或失明可能性高的甲醇中毒患者。除了对视力受损患者进行随访外,建议未来的研究对所创建的列线图进行外部验证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/577b/11617918/52515f067072/ga1.jpg

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