Clinical profile of patients presenting with mushroom toxicity in a tertiary care setup in Northeast India: with special focus on model for end-stage liver disease score as a predictor of disease outcome

Abstract

Background: Ingestion of wild mushrooms leading to toxicity is a common phenomenon every year during the rainy season in Upper Assam, India. The model for end-stage liver disease (MELD) score was developed to predict mortality in a specific group of patients with decompensated chronic liver disease. It has also been used to predict mortality in patients with acute liver failure, which is also one of the dreaded complications of mushroom toxicity. There are only a couple of studies in the world that have studied MELD score as a predictor of outcomes in patients with mushroom toxicity and to the best of our knowledge, this is the first such study done in India. Methods: In this hospital-based observational study, 35 patients aged >13 years with an alleged history of ingestion of wild mushrooms, but no other cause of hepatic dysfunction were included in this study. Disease outcome (discharged/expired) was correlated with both MELD score and day of presentation from symptom onset. Results: The mean age was 32.54 years with a male-to-female sex ratio of 4:5 among the study participants. Gastrointestinal symptoms, including loose stool, vomiting, pain abdomen, and jaundice, were the most common. The MELD score was significantly higher in patients who succumbed to the toxin (p<0.05) and positively correlated with mortality (r=0.664, p<0.001) and a later day of presentation (r=0.226, p=0.123). A later-day presentation also positively correlated with mortality (r=0.227, p=0.189). Conclusions: The MELD score can be used as a prognostic tool in patients with mushroom toxicity.