APACHE Score, Severity Index of Paraquat Poisoning, and Serum Lactic Acid Concentration in the Prognosis of Paraquat Poisoning of Chinese Patients

Abstract

Many prognostic indictors have been studied to evaluate the prognosis of paraquat poisoning. However, the optimal indicator remains unclear. To determine the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Severity Index of Paraquat Poisoning (SIPP), and serum lactate levels in the prognosis of paraquat poisoning, we performed a prospective study that enrolled 143 paraquat patients. Data were collected from patients (161) at West China Hospital in Chengdu, China, including details about the patients' general conditions, laboratory examinations, and treatment. Receiver operating characteristic curves for predicting inpatient mortality based on APACHE II score, SIPP, and lactate levels were generated. To analyze the best cutoff values for lactate levels, APACHE II scores, and SIPP in predicting the prognosis of paraquat poisoning, the initial parameters on admission and 7-day survival curves of patients with lactate levels greater than or equal to 2.95 mmol/L, APACHE II score greater than or equal to 15.22, and SIPP greater than or equal to 5.50 h · mg/L at the time of arrival at West China Hospital were compared using the 1-way analysis of variance and the log-rank test. The APACHE II score (5.45 [3.67] vs 11.29 [4.31]), SIPP (2.78 [1.89] vs 7.63 [2.46] h · mg/L), and lactate level (2.78 [1.89] vs 7.63 [2.46] mmol/L) were significantly lower in survivors (77) after oral ingestion of paraquat, compared with nonsurvivors (66). The APACHE II score, SIPP, and lactate level had different areas under the curve (0.847, 0.789, and 0.916, respectively) and accuracy (0.64, 0.84, and 0.89, respectively). Respiratory rate, serum creatinine level, Paco2, and mortality rate at 7 days after admission in patients with lactate levels greater than or equal to 2.95 mmol/L were markedly different compared with those of other patients (P < 0.05). The predictive value of lactic acid was superior to that of APACHE II score and SIPP for acute oral paraquat poisoning.

The value of APACHE II in predicting mortality after paraquat poisoning in Chinese and Korean population

“…1 ). Ten studies were published in English [ 8 , 11 , 19 – 26 ] and 19 studies were published in Chinese, [ 27 – 45 ] as shown in Table 1 . Twenty-seven studies were conducted in Chinese and 2 studies in Korean.…”

“…The cutoff value of the APACHE II score was ≥10 in 7 of the studies. [ 8 , 19 , 20 , 24 , 25 , 32 ] The pooled sensitivity of the APACHE II score ≥10 for predicting mortality was 88% (95% CI 71%–95%), and the pooled specificity was 84% (95% CI 67%–93%; Fig. 6 ).…”

“…It is calculated by multiplying the time since PQ ingestion (hour) by the concentration in the plasma (mg/L). [ 7 , 8 ] However, many hospitals do not have access to assaying the plasma PQ level, which limits the accurate evaluation of poisoning severity.…”

“…Several studies have used the APACHE II scoring system in PQ-poisoned patients to assess prognosis. [ 8 , 10 ] However, as a scoring system that is widely applied for general critically ill patients, some authors proposed that the APACHE II system might underestimate mortality in poisoned patients. [ 11 ] Moreover, previous studies showed a discordant predictive value of this scoring system.…”

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

“…When doctors recognize the degree of toxicity of PQ poisoning in patients sufficiently early, they can prescribe specific and targeted treatments efficiently and potentially save the patient's life. The mortality rate of PQ poisoning is highly correlated with PQ concentrations [29]; however, there is no recognized method of comprehensively evaluating the relationship of clinical indexes with PQ poisoning. There is a particular lack of knowledge regarding the clinical implications of BRT in PQ poisoning.…”