의식이 명료한 글루포시네이트 중독환자의 신경학적 예후인자로서 APACHE II의 유용성
Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status
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Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related toa poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whetherthe Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurologicalprognosis in patients with glufosinate poisoning who present to the emergency room with alert mentalstatus. Methods: This study was conducted retrospectively through a chart review for patients over 18 yearswho presented to a single emergency medical center from January 2018 to December 2022 due to glu fosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Per formance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether anyvariables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poorprognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion ofalcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844),1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II scorecutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, withan AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95%CI, 0.527–0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis ofpatients with glufosinate poisoning who have alert mental status.
Abstract
Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related toa poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whetherthe Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurologicalprognosis in patients with glufosinate poisoning who present to the emergency room with alert mentalstatus. Methods: This study was conducted retrospectively through a chart review for patients over 18 yearswho presented to a single emergency medical center from January 2018 to December 2022 due to glu fosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Per formance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether anyvariables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poorprognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion ofalcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844),1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II scorecutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, withan AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95%CI, 0.527–0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis ofpatients with glufosinate poisoning who have alert mental status.
참고문헌 (28)
- Hirose Y, "A toxicokinetic analysis in a patient with acute glufosinate poisoning", Hum Exp Toxicol, 18, pp.305~308 (1999)[DOI]
- Kang JH, "Clinical considerations of intoxication caused by a herbicide containing glufosinate ammonium : 6 cases analysis", J Korean Soc Emerg Med, 9, pp.652~658 (1998)
- Hack R, "Glufosinate ammonium : some aspects of its mode of action in mammals", Food Chem Toxicol, 32, pp.461~470 (1994)[DOI]
- Mao YC, "Acute human glufosinate-containing herbicide poisoning", Clin Toxicol(Phila), 50, pp.396~402 (2012)[DOI]
- 이두성, "단일 응급의료기관에서 경험한 글루포시네이트 암모니움 포함 제초제 중독 후 중증도 예측에 관한 연구", 대한임상독성학회지, 17(1), pp.7~13 (2019), 대한임상독성학회[DOI]
- Watanabe T, "Neurological effects of glufosinate poisoning with a brief review", Hum Exp Toxicol, 17, pp.35~39 (1998)[DOI]
- 오태환, "의식이 명료한 상태로 내원한 글루포시네이트 중독환자에서 신경학적 합병증예측인자로서 암모니아 농도 차이의 유용성", 대한응급의학회지, 27(5), pp.429~435 (2016), 대한응급의학회
- Lee SW, "Epidemiology and clinical analysis of poisoning of glufosinate herbicide-multicenter study", J Korean Soc Clin Toxicol, 5, pp.36~42 (2007)
- 황인우, "Glufosinate Ammonium (Bastaⓡ)중독의 임상적 특성 고찰", 대한응급의학회지, 15(2), pp.75~79 (2004), 대한응급의학회
- 고은나래, "글루포시네이트 암모늄 제초제 중독환자에서 혈중 암모니아 농도와 사망률과의 연관성에 대한 연구", 대한임상독성학회지, 18(2), pp.136~140 (2020), 대한임상독성학회[DOI]
- Park KN, "APACHE III score as a prognostic parameter in acute pancreatitis", Korean J Gastroenterol, 32, pp.508~515 (1998)
- Wagner DP, "Statistical validation of a severity of illness measure", Am J Public Health, 73, pp.878~884 (1983)[DOI]
- 유대한, "Glufosinate 중독 환자의 신경학적 예후 인자로서 APACHE II Score의 유용성", 대한임상독성학회지, 14(2), pp.107~114 (2016), 대한임상독성학회[DOI]
- Persson HE, "Poisoning severity score : grading of acute poisoning", J Toxicol Clin Toxicol, 36, pp.205~213 (1998)[DOI]
- Jennett B, "Assessment of outcome after severe brain damage", Lancet, 1, pp.480~484 (1975)[DOI]
- Ian Jacobs, "Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports", Circulation, 110(21), pp.3385~3397 (2004), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Lee JH, "Prognostic factor determination mortality of acute glufosinate-poisoned patients", Hum Exp Toxicol, 38, pp.129~135 (2019)[DOI]
- Kaur H, "The significance of APACHE II as a predictor of mortality in paraquat poisoning : a systematic review and meta-analysis", J Forensic Leg Med, 97, pp.102548~ (2023)[DOI]
- Adalarasan V, "Evaluating the use of APACHE II score in predicting the severity and clinical outcomes of organophosphorous poisoning : original study", Indian J Forensic Med Toxicol, 17, pp.170~174 (2023)[DOI]
- Moorthy K, "Comparison of the Poisoning Severity Score, Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II Score with lactate to assess the outcome in acute organophosphorus poisoning", Indian J Forensic Med Toxicol, 17, pp.82~85 (2023)[DOI]
- Danah Abo AlSamh, "Neurologic Complications in Critically Ill Patients with Toxic Alcohol Poisoning: A Multicenter Population-Based Cohort Study", Neurocritical Care, 40(2), pp.734~742 (2023), Springer Science and Business Media LLC[DOI]
- Bloch RS, "Acute alcohol intoxication : significance of the amylase level", Ann Emerg Med, 12, pp.294~296 (1983)[DOI]
- Eckfeldt JH, "Hyperamylasemia following methyl alcohol intoxication : source and significance", Arch Intern Med, 146, pp.193~194 (1986)[DOI]
- Hsiao CT, "Acute pancreatitis following organophosphate intoxication", J Toxicol Clin Toxicol, 34, pp.343~347 (1996)[DOI]
- Zobeiri M, "Serum amylase as a prognostic marker of organophosphate poisoning", J Inj Violence Res, 13, pp.117~120 (2021)[DOI]
- Dagli AJ, "Pancreatic involvement in malathion : anticholinesterase insecticide intoxication : a study of 75 cases", Br J Clin Pract, 37, pp.270~272 (1983)[DOI]
- Dhanarisi J, "Relationship between alcohol co-ingestion and clinical outcome in pesticide self-poisoning : a systematic review and meta-analysis", Alcohol Alcohol, 58, pp.4~12 (2023)[DOI]
- J. H. Eckfeldt, "Hyperamylasemia following methyl alcohol intoxication. Source and significance", Archives of Internal Medicine, 146(1), pp.193~194 (1986), American Medical Association (AMA)[DOI]