Abstract
Acute respiratory failure is the primary cause of mortality in patients with acute pesticide poisoning. The aim of the present study was to develop a new and efficient score system for predicting acute respiratory failure in patients with acute pesticide poisoning. This study was a retrospective observational cohort study comprised of 679 patients with acute pesticide poisoning by intentional poisoning. We divided this population into a ratio of 3:1; training set (n = 509) and test set (n = 170) for model development and validation. Multivariable logistic regression models were used in developing a score-based prediction model. The Prediction of Respiratory failure in Pesticide intoxication (PREP) scoring system included a summation of the integer scores of the following five variables; age, pesticide category, amount of ingestion, Glasgow Coma Scale, and arterial pH. The PREP scoring system developed accurately predicted respiratory failure (AUC 0.911 [0.849−0.974], positive predictive value 0.773, accuracy 0.873 in test set). We came up with four risk categories (A, B, C and D) using PREP scores 20, 40 and 60 as the cut-off for mechanical ventilation requirement risk. The PREP scoring system developed in the present study could predict respiratory failure in patients with pesticide poisoning, which can be easily implemented in clinical situations. Further prospective studies are needed to validate the PREP scoring system.
Highlights
Pesticides are a large and heterogeneous group of chemicals which include insecticides, herbicides, and fungicides meant to control pests
Respiratory failure is the primary cause of mortality, the clinical features of each pesticide poisoning case might be different depending on the chief ingredient of the pesticide ingested
We excluded the patients with paraquat poisoning, those who visited the hospital more than 24 h after pesticide ingestion, and those diagnosed with respiratory failure within one hour from hospital arrival
Summary
Pesticides are a large and heterogeneous group of chemicals which include insecticides, herbicides, and fungicides meant to control pests. Along with their advantages, pesticides poisoning is a major public health concern worldwide. While pesticides are characterized by various degrees of toxicity, high mortality is a common feature with all types of pesticide poisoning [1,2]. A majority of the deaths result from different complications including arrhythmia, hypotension, acid-base disturbance, and respiratory failure [3–5]. Respiratory failure is the primary cause of mortality, the clinical features of each pesticide poisoning case might be different depending on the chief ingredient of the pesticide ingested. Among the types of pesticide poisoning, the relationships of organophosphate and carbamate poisoning with respiratory failure have been widely studied [6–8] even though respiratory failure is observed in patients with other pesticide poisoning
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