Abstract
BackgroundPulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning.MethodsLung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis.ResultsOf 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and “no obvious lesion”. With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001).ConclusionsThe volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
Highlights
Paraquat (PQ; 1,1-dimethyl-4,4-bipyridinium dichloride) is a highly toxic herbicide to humans [1,2,3,4]
Among the eight different types of lung computed tomography (CT) findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and “no obvious lesion”
With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores
Summary
Paraquat (PQ; 1,1-dimethyl-4,4-bipyridinium dichloride) is a highly toxic herbicide to humans [1,2,3,4]. A uniformly used prognostic indicator that reliably predicts the risk of death at an early stage in poisoning is of great importance in assessing clinical benefit from various interventions [1, 2]. Most variables that are associated with mortality are non-specific to abnormalities of pulmonary pathophysiology, such as estimated amount of PQ ingestion [4], plasma and urine PQ concentration [5, 6], severity index for paraquat poisoning (SIPP) [7], acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment (mSOFA) scores [8, 9], liver enzymes, serum creatinine (SCr) and absolute lymphocyte count levels [10,11,12]. Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning
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