| Objective:To explore the relationship between early clinical indexes and prognisis in patients with acute severe organophosphorus pesticide poisoning(ASOPP),and provide references for the treatment and prognosis of ASOPP.Methods:213 patients with acute organophosphorus pesticide poisoning were admitted into the First Hospital of Jilin University,the Eastern Division,during Jan.2014 to Dec.2016.According to the inclusion and exclusion criteria,130 ASOPP patients were selected.The clinical information concluded:prognisis,gender,age,toxin dose,types of toxin,time elapsed from poisoning to gastric lavage,whether hemoperfusion(HP),routine blood test,cholinesterase,blood glucose,alanine aminotransferase(ALT),total bilirubin(TBIL),creatinine(CRE),blood urea nitrogen(BUN),creatine kinase isoenzyme,blood amylase,arterial potential of hydrogen(PH),arterial lactic acid(Lac),arterial partial pressure of oxygen(Pa O2),arterial partial pressure of carbon dioxide(Pa CO2),arterial bicarbonate radical(HCO3-),blood calcium bicarbonate,recorded of the types and numbers of organ damage,glasgow coma scale(GCS)score and the acute physiology and chronic health evaluation II(APACHE II).According to the prognosis,the patients were divided into survival group(n=107)and death group(n=23),used a single factor to analysis the differences between the two groups of above indexes;used Spearman to analysis indexes and prognosis;draw the receiver’s operating characteristic curve(ROC curve)with these clinical indexes,then used it to assess the value of each index and predicted the prognosis of ASOPP patients.Results:(1)130 ASOPP patients,107 cases were survived,23 cases were died,and the mortality rate was 17.69%,61 cases(46.9%)were male,69 cases(53.1%)were female,male: female =0.88:1;47 cases(43.9%)were male and 60 cases(56.1%)were female in survival group,14 cases(60.9%)were male and 9 cases(39.1%)were female in death group,the two groups had no statistically significant difference in gender(P>0.05).The age of the two groups was between 14 to 84 years old,and the average age was 47.21 ± 16.50 years old.Most poisoning people were young [58cases(44.62%)],the elderly accounted for the largest number of poisoning deaths[13(56.52%)].The average age of death group was 58 ± 18.638 years old,the average age of survival group was 44.89 ± 15.121 years old,there was statistically significant difference between the two groups(P<0.01);(2)Among 130 cases of ASOPP patients,the toxin dose was 10 ~ 500 ml,the average toxin dose was 102.19 ± 88.388ml;the toxin dose of survival group was 50(50,100 ml),the toxin dose of death group was 100(100,250 ml),the toxin dose of the death group was more than that in survival group,there was statistically significant difference between the two groups(P<0.01);(3)The time elapsed from poisoning to gastric lavage in the death group was longer than that in the survival group,and the proportion of HP was lower than that of the survival group,there were statistically significant differences between the two groups(all P<0.01);(4)In the laboratory projects,cholinesterase,blood calcium bicarbonate,PH,Pa O2,HCO3-of the death group were lower than those in the survival group,there were statistically significant differences between the two groups(all P<0.01);the level of blood glucose,ALT,CRE,blood amylase,creatine kinase isoenzyme,Lac and Pa CO2 in death group were higher than those in survival group,there were statistically significant differences between the two groups(all P<0.05);(5)The GCS score of the death group was significantly lower than that of the survival group,the APACHE II score of the death group was higher than that of the survival group,there were statistically significant differences between the two groups(all P<0.01);(6)ASOPP,the main organs which suffer from early injury included brain,lung,heart,circulation,liver,kidney,pancreas,gastrointestinal tract,in which the brain,lung,heart were the most serious,followed by pancreas;the incidence rate of organ damage in survival group was ordered from high to low: brain,lung,pancreas,heart,liver,circulation,kidney;the incidence rate of organ damage in death group was ordered from high to low: brain,heart,lung,gastrointestinal tract,circulating,pancreas,liver,kidney,there was no significant difference in the incidence rate of pancreatic injury between the two groups(P>0.05),the incidence rate of residual organ damage in the death group was higher than that in the survival group,there were statistically significant differences between the two groups(all P<0.01);the number of organ damage occurred early in the death group was 4(4,5),which was significantly higher than that in the survival group(0,1),there was statistically significant difference between the two groups(P<0.01);(7)Spearman correlation analysis suggested that the strong indexes(absolute value of correlation coefficient r >0.4)that in relation to prognosis included blood glucose(r=0.417),blood calcium bicarbonate(r=-0.415),PH(r=-0.469),Lac(r=0.469),Pa O2(r=-0.409),GCS score(r=-0.649)and APACHE II score(r=0.592),numbers of organ damage(r=0.661),there were statistically significant differences between the two groups(all P<0.01);the blood glucose,Lac,APACHE II score,numbers of organ damage were positively correlated with prognosis,and blood calcium bicarbonate,PH,Pa O2,GCS score were negatively correlated with prognosis;(8)The area under the ROC curve(AUC)was used to assess the predictive value of each index for the prognosis of patients with ASOPP that was ordered from high to low: numbers of organ damage[AUC=0.981,confidence interval(95%CI)=0.959 ~1.0,P<0.01],GCS score[AUC=0.951,confidence interval(95%CI)=0.913 ~ 0.989,P<0.01],APACHE II [AUC=0.947,confidence interval(95%CI)=0.906 ~ 0.988,P<0.01],Lac[AUC=0.855,confidence interval(95%CI)=0.781 ~ 0.928,P<0.01],PH[AUC=0.855,confidence interval(95%CI)=0.752 ~ 0.958,P<0.01],blood glucose [AUC=0.815,confidence interval(95%CI)=0.720 ~ 0.911,P<0.01],bloodcalcium bicarbonate [AUC=0.813,confidence interval(95%CI)=0.734 ~ 0.893,P<0.01],Pa O2[AUC=0.810,confidence interval(95%CI)=0.721 ~ 0.898,P<0.01].Conclusions:(1)In ASOPP,age,toxin dose,time elapsed from poisoning to gastric lavage,cholinesterase,blood glucose,ALT,CRE,blood calcium bicarbonate,serum amylase,creatine kinase isoenzyme,PH,Lac,Pa O2,Pa CO2,HCO3-,GCS score,APACHE II,numbers of organ damage were early warning indicators for the evaluation of prognosis;(2)The analysis of ROC curve suggested that the prognostic value of the indexes who had higher predictive value were numbers of organ damage,GCS score,APACHE II,followed by PH,Lac,blood glucose,blood calcium bicarbonate,Pa O2;(3)HP can reduce the mortality rate of ASOPP;(4)In ASOPP,organ damage in the brain,lung,heart were the most serious,the incidence rate of organ damage was higher in the death group. |
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