Prognostic factors of acute aluminum phosphide poisoning

Abstract

In Morocco, acute aluminum phosphide poisoning (AAlPP) is a serious health care problem. It results in high mortality rate despite the progress of critical care. The present paper aims at determining the characteristics of AAlPP and evaluating its severity factors. We studied consecutive patients of AAlPP admitted to the medical intensive care unit (ICU) (Ibn Sina Hospital, Rabat, Morocco) between January 1992 and December 2007. Around 50 parameters were collected, and a comparison was made between survivor and nonsurvivor groups. Data were analyzed using Fisher exact test, Mann-Whitney U test and Cox regression model. Forty-nine patients were enrolled: 31 females and 18 males; their average age was 26+/-11 years. The ingested dose of aluminum phosphide was 1.2+/-0.7 g. Self-poisoning was observed in 47 cases, and the median of delay before admission to the hospital was 5.3 hours (range, 2.9-10 hours). Glasgow coma scale was 14+/-2. Shock was reported in 42.6% of the patients. pH was 7.1+/-0.4, and bicarbonate concentration was 16.3+/-8.8 mmol/L. Electrocardiogram abnormalities were noted in 28 (57%) cases. The mortality rate was 49% (24 cases). The prognostic factors were APACHE II (P=0.01), low Glasgow coma scale (P=0.022), shock (P=0.0003), electrocardiogram abnormalities (P=0.015), acute renal failure (P=0.026), low prothrombin rate (P=0.020), hyperleukocytosis (P=0.004), use of vasoactive drugs (P<0.001), use of mechanical ventilation (P=0.003). Multivariate analysis by logistic regression revealed that mortality in AAlPP correlated with shock (RR=3.82; 95% CI=1.12-13.38; P=0.036) and altered consciousness (RR=3.26; 95% CI=1.18-8.99; P=0.022). AAlPP is responsible for a high mortality, which is primarily due to hemodynamic failure.