The Value Of Early Liver Injury Indicators In Evaluating The Prognosis Of Patients With Acute Paraquat Poisoning

Objective:To explore the predictive value of early liver injury indicators in patients with acute paraquat poisoning(APP)on the prognosis of patients with mild to moderate and severe acute paraquat poisoning.The prognostic assessment of patients with acute paraquat poisoning provides evidence.Methods:We retrospectively analyzed the clinical materials of 476 patients,suffered from acute paraquat poisoning,admitted in the department of emergency medicine or the emergency intensive Care Unit(EICU)of the first affiliated hospital of Zhengzhou university during the term between March 1st 2013 to April 30th 2017.Data(gender,age,time of admission and admission,past history,time from poisoning to consultation,dose of poison,etc.),urine paraquat concentration and indicators of liver injury of 24 hours after admission(total bilirubin,direct bilirubin,indirect bilirubin,Aspartate aminotransferase,alanine aminotransferase,y-glutamyl transpeptidase),the prognosis of patients in the hospital and telephone follow-up of patients who improved after discharge,divided into survival group and death group by prognosis within 30 days after poisoning According to the concentration of urinary paraquat in mild to moderate poisoning groups,rapid semi-quantitative detection of urine(sodium bicarbonate-sodium dithionite method).The concentration of paraquat ≤30 μg/ml is the mild to moderate poisoning group.Detect(sodium bicarbonate-sodium dithionite method)paraquat concentration>30μg/ml as the severe poisoning group.Multivariate logistic regression analysis was used to analyze the independent risk factors of paraquat poisoning.Draw receiver operating characteristic(ROC)curves were prognostic evaluation,and Kaplan-Meier survival analysis,to explore the early acute hepatic injury indicators paraquat poisoning patients with mild to moderate and severe acute paraquat poisoning predictive value of patient prognosis.Results:A total of 476 cases were received,including 202 males and 274 females.282(59.2%)survived,and 194(40.8%)died.①When the concentration of urinary paraquat was less than or equal to 30 μg/ml,the toxic dose,urinary paraquat concentration,y-glutamyl transpeptidase,and direct bilirubin were statistically significant in the survival group and the dead group(P<0.05),is an independent risk factor.The areas under the ROC curve were 0.898,0.833,0.761,0.758,respectively,with a dose of ≥30ml,a concentration of urinary paraquat≥2.69μg/ml,γ-glutamyl transpeptidase≥27.9U/L,and direct bilirubin≥8.4μmol/L is the critical value for judging the prognosis.Its sensitivity and specificity for judging survival are 82.14%and 85.31%,85.71%and 78.20%,57.14%and 85.71%,46.43%and 93.84%,respectively.②When the concentration of urinary paraquat was greater than 30 μg/ml,the toxic dose and γ-glutamyl transpeptidase were statistically significant in the survival group and the dead group(p<0.05),is an independent risk factor.The areas under the ROC curve were 0.836 and 0.746,respectively.The dose of≥45ml is the critical value for judging the prognosis.The sensitivity and specificity for judging survival are 81.88%and 70.00%,respectively.The critical value for judging the prognosis is y-glutamyl transpeptidase≥20.6 U/L.The sensitivity and specificity for judging survival were 58.70%and 87.50%,respectively.Conclusion:Direct bilirubin elevation in early liver injury indicators can be used as a predictor of the prognosis of patients with mild to moderate paraquat poisoning,and y-glutamyl transpeptidase can be used to predict the prognosis of patients with mild to moderate paraquat poisoning.