Clinical Analysis Of 66 Cases Of Mushroom Poisoning And Discussion The System Of Condition Assessment

Objective:To study the clinical characteristics,prognostic factors and differenttreatmentmethodsofpatientswithmushroom poisoning（MP）.Analysis of the relevance of PSS,CTP,MELD and SOFA for the assessment of concurrent MODS and deaths in MP patients,and exploration of its value in the assessment of clinical conditions and prediction of clinical outcomes,so as to achieve the purpose of early warning,treatment guidance,life saving and resource saving.Methods:Through the electronic medical record platform search and browse patients diagnosed as"toadstool poisoning".According to inclusion criteria and exclusion criteria selected subjects.Their clinical data,first laboratory examination,and treatment were collected in a self-made table,as well as the scores obtained according to the PSS score table,CTP grading,MELD calculation formula,and SOFA score table.The subjects were divided into MODS group and non-mods group based on whether MODS occurred during hospitalization.Survival at discharge was divided into death group and survival group.Summary the data by using Microsoft Excel 2010and analyzed by SPSS19.0 statistical.Results:1.Iculuded 66 MP patients in hunan provincial people’s hospital from June^1st,2012 to September^30th,2018.There are 28patients in MODS group and 38 patients in non-mods group,12patients in the death group and 54 patients in the survival group.2.Clinical data:There was no significant correlation between gender,age,residence in rural area or urban area,incubation period and the MP patients with MODS（P>0.05）.There was a correlation between clinical time,at the same time with vomiting,diarrhea,abdominal pain onset and the MP patients with MODS（P<0.05）,but it dosn’t enter the binary logistics regression equation,indicating that the correlation is not close.There was no significant correlation between gender,age and the MP patients who has dead（P>0.05）.There was a correlation between residence in rural area or urban area,incubation period,clinical time,at the same time with vomiting,diarrhea,abdominal pain onset and the MP patients who has dead（P<0.05）,but it dosn’t enter the binary logistics regression equation,indicating that the correlation is not close.The poisoning season of 66patients was concentrated in late spring and early summer.Thirty-one cases of mushrooms were known,19 were Amanita rimosa and 12were Amanita fuliginea.3.Treatment condition:MP patients were treated with unabsorbed toxin removal measures or silybin treatment within 6hours were unassociated with MODS or death（P>0.05）,but the morbidity of MODS and mortality in the receiving group were lower than those in the non-receiving group.MP patients were treated with lucid ganoderma or hemoperfusion were unassociated with MODS and death（P<0.05）,but the morbidity of MODS and mortality in the receiving group werehigher than those in the non-receiving group.MP Patients were treated with sodium dimercaptopropane sulfonate injection were associated with MODS and death（P<0.05）,but the morbidity and mortality of MODS in the receiving group were higher than those in the non-receiving group.Patients were treated with hemoperfusion within 48 hours were unassociated with MODS（P>0.05）,but the morbidity of MODS in the≤48h receiving group was lower than that in the>48h receiving group.However patients were treated with hemoperfusion within 48 hours were associated with death（P<0.05）,and the mortality in the≤48h receiving group was lower than that in the>48h receiving group.4.Laboratory examination:There was no significant correlation between WBC,PLT,ALT,AST,ALb and the MP patients with MODS（P>0.05）.There was a correlation between TB,PT,APTT,PTA,INR,BUN,Scr and the MP patients with MODS（P<0.05）.TB,PT,APTT,PTA,INR and CR entered the binary logistic regression analysis equation,indicating a close correlation with the MP patients who has MODS（P<0.05）,and OR>1.However BUN did not enter the equation.There was no significant correlation between WBC,PLT,ALT,AST,ALb,APTT,BUN,Scr and the MP patients who has dead（P>0.05）.There was a correlation between TB,PT,PTA,INR and the MP patients who has dead（P<0.05）.TB,PT,PTA,INR entered the binary logistic regression analysis equation,indicating a close correlation with the MP patients who has MODS（P<0.05）,and OR>1.5.Scoring system:There was a correlation between PSS,CTP,MELD,SOFA and the MP patients with MODS（P<0.05）.Discovered by Classification of logistics regression analysis and ROC curve:The clinical application value of PSS is low（AUC=0.602）and it has only theabilitytojudge,butnottheabilitytojudge correctly（Sensitivity=100%,Specificity=0）.CTP and SOFA have clinicalapplicationvalue（AUC=0.740,AUC=0.767）,Butthe sensitivity（66.70%,75.00%）and specificity（18.50%,28.90%）were low.There was a significant correlation between MELD and the MP patients with MODS（P<0.05）,and OR<1.MELD has very good predictive accuracy（AUC=0.807）,High sensitivity and specificity（77.86%,76.30%）.The yoden index determined when MELD≥22.415the MP patients were have MODS.There was no significant correlation between PSS and the MP patients who has dead（P>0.05）.There was a significant correlation betweenCTP,MELD,SOFA and the MP patients who has dead（P<0.05）.Discovered by Classification of logistics regression analysis and ROC curve:The clinical application value,ability to judge and to judge correctly of PSS is low（AUC=0.672,Sensitivity=46.4%,Specificity=13.2%）.MELD and SOFA have clinical application value（AUC=0.730,AUC=0.711）.At the same sensitivity（66.7%）,MELD standard error is smaller（Sem=0.092）and specificity is stronger（85.2%）.The yoden index determined when MELD≥26.905 the MP patients were die.Conclusion:1.For patients with a history of consumption of unidentified fungi,the clinical manifestations were vomiting,diarrhea,abdominal pain and other manifestations of the digestive system should test blood routine,liver function,kidney function and coagulation function.2.TB,PT,APTT,PTA,INR and Scr were risk factors for complicated MODS in MP patients.TB,PT,PTA and INR were risk factors for death in MP patients.3.Early removal of unabsorbed toxins such as gastric lavage and diarrhea in MP patients is expected to reduce the incidence of MODS and death in patients with toadstool poisoning.Patients with MP should receive hemoperfusion as early as possible,preferably within48 hours to reduce the risk of death.There is still no evidence to support the existence of specific antidote for toadstool poisoning.4.CTP,MELD and SOFA are of clinical value in the assessment of MP patients’conditions and the prediction of their clinical outcomes.There was a positive correlation between MELD and MP patients with MODS and death,and the sensitivity and specificity were significantly higher than CTP and SOFA.5.To calculate the MELD score according to the patients’first laboratory examination.When MELD≥22.415,it was the critical threshold to predict the occurrence of MODS in MP patients;when MELD≥26.905 points,it was the critical threshold to predict the death of MP patients.