| Objective:To explore the feasibility of assessing the severity and prognosis of initial arterial lactate and lactate clearance rate and oxygenation index in patients with acute paraquat poisoning.Methods:To collect 165 cases of patients with acute paraquat poisoning who were admitted to the Second People’s Hospital of Yunnan Province from January,2018 to December,2019.The subjects were enrolled in strict accordance with the inclusion and exclusion criteria and clinical data were collected,including sex,age,amount of poison taken,time from taking poison to treatment and gastric lavage and catharsis,results of urinary paraquat semi-quantitative detection,whether to receive gastric lavage and blood purification treatment,oxygenation index and lactate and lactate clearance rate at admission,oxygenation index within 24/48 hours,lactate and lactate clearance rate within 6/12/24 hours,and disease prognosis.The survival of patients admitted to the group was followed by telephone.The patients were divided into early survival group and early death group according to prognosis,and were divided into mild type and moderate-severe type according to the results of urinary paraquat semi-quantitative detection.The lactate and lactate clearance rate and oxygenation index of two groups were analyzed statistically.Results:1 Case data165 patients were collected into research who aged from 12 to 72 years old,and the ratio of men and women was 1.14:1.The all routes of intoxication were oral administration of paraquat.All patinets were given the treatment of gastric lavage and catharsis,meanwhile,they were gave antioxidant therapy and organ function support.Then,patients would received hemoperfusion and hemodialysis according to their severity of poisoning.99 patients survived and 66 patients died after telephone follow-up in 28 days.The fatality rate of acute paraquat poisoning was 40%.2 Assessment of initial arterial blood lactate clearance rate and oxygenation index on degree of poisoning of patients with acute paraquat poisoningAccording to the results of urinary paraquat semi-quantitative detection,subjects were divided into the mild type(0-10ug/ml,n=76)and moderate-severe type(>10ug/ml,n=89).2.1 Comparison of all observation indexes between the mild type and moderate-severe typeThere were no significant differences in sex and age between the mild type and moderate-severe type(P>0.05).However,there were statistically significant differences in the amount of poison taken and the time from taking poison to treatment/gastric lavage/catharsis between two types(P<0.05).There were significant differences in lactate within 0/6/12/24 hours and lactate clearance rate within 6/12/24 hours and oxygenation index within 0/24/48 hours between two types(P<0.05).2.2 Analysis of spearman’s correlation between all observation indexs and the patients’ degree of poisoningThe amount of poison taken in patients with acute paraquat poisoning was positively correlated with the degree of poisoning(rs=0.401,P<0.05).There was a positive correlation between the time from taking poison to treatment/gastric lavage/catharsis and the degree of poisoning(rs=0.182/0.194,P<0.05).The lactate within 0/6/12/24 hours had a positive correlation with the degree of poisoning(rs=0.356/0.359/0.354/0.352,P<0.05).The lactate clearance rate within 6/12/24 hours had a negative correlation with the degree of poisoning(rs=-0.337/-0.322/-0.1 85,P<0.05).The oxygenation index within 0/24/48 hours had a negative correlation with the degree of poisoning(rs=-0.232/-0.541/-0.603,P<0.05),and the oxygenation index within 48 hours had the strongest correlation with the patients’ degree of poisoning.3 Prognostic evaluation of initial arterial lactate clearance rate and oxygenation indexs on patients with paraquat poisoningThe patients were divided into early survival group(n=99)and early death group(n=66)according to the prognosis.3.1 Comparison of all observation indexes between early survival group and early death groupThere were no significant differences in sex and age between two group(P>0.05).However,there were statistically significant differences in the amount of poison taken and the time from taking poison to treatment/gastric lavage/catharsis and the lactate within 0/6/12/24 hours and the lactate clearance rate within 6//12/24 hours and the oxygenation index within 0/24/48 hours between two group(P<0.05).3.2 Analysis of spearman’s correlation between all observation indexs and deathThere was a positive correlation between the amount of poison taken and death in acute paraquat poisoning patients(rs=0.187,P<0.05).There was a positive correlation between the time from taking poison to treatment/gastric lavage/catharsis and death in acute paraquat poisoning patients(rs=0.274/0.297,P<0.05).The lactate within 0/6/12/24 hours had a positive correlation with death(rs=0.596/0.591/0.632/0.651,P<0.05),and the lactate within 24 hours had the strongest correlation with death.The lactate clearance rate within 6/12/24 hours had a significant negative correlation with death(rs=-0.484/-0.742/-0.629,P<0.05),and the lactate clearance rate within 12 hours had the strongest correlation with death.The oxygenation index within 0/24/48 hours had a negative correlation with death(rs=-0.331/-0.659/-0.657,P<0.05),and the oxygenation index within 24 and 48 hours were strongly correlated with death.3.3 The ROC curve of all observation indexs in predicting deathThe AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the amount of poison taken in predicting death were 0.607/0.02/0.517-0.697/45/45.5%/73.7%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the time from taking poison to treatment in predicting death were 0.661/<0.01/0.579-0.743/7.5/69.7%/52.5%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the time from taking poison to gastric lavage and catharsis in predicting death were 0.675/<0.01/0.594-0.756/8.5/72.7%/52.5%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate at admission in predicting death were 0.851/<0.01/0.795-0.907/3.95/87.9%/67.7%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate within 6 hours in predicting death were 0.848/<0.01/0.792-0.904/3.55/89.4%/67.7%.TheAUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate within 12 hours in predicting death were0.872/<0.01/0.821-0.924/3.35/89.4%/73.7%.TheAUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate within 24 hours in predicting death were 0.883/<0.01/0.834-0.932/2.95/90.9%/74.7%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate clearance rate within 6 hours in predicting death were 0.785/<0.01/0.717-0.852/10.13/84.8%/62.6%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the lactate clearance rate within 12 hours in predicting death were 0.937/<0.01/0.902-0.972/15.61/84.8%/88.9%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of lactate clearance rate within 24 hours in predicting death were 0.871/<0.01/0.813-0.928/23.905/87.9%/79.8%.TheAUC/P/95%CI/Cut-off/Sensitivity/Specificity of the oxygenation index at admission in predicting death were 0.695/<0.01/0.614-0.776/327.5/81.8%/49.5%.TheAUC/P/95%CI/Cut-off/Sensitivity/Specificity of the oxygenation index within 24 hours in predicting death were 0.888/<0.01/0.839-0.937/288/77.3%/84.8%.The AUC/P/95%CI/Cut-off/Sensitivity/Specificity of the oxygenation index within 48 hours in predicting death were 0.887/<0.01/0.836-0.939/260.5/66.7%/99%.Conclusions:1.The amount of poison taken and the time from taking poison to treatment/gastric lavage/catharsis and initial arterial lactate and lactate clearance rate and oxygenation index have strong clinical value in evaluating the degree of poisoning.2.The amount of poison taken and the time from taking poison to treatment/gastric lavage/catharsis and initial arterial lactate and lactate clearance rate and oxygenation index can be used as one of the prognostic indexes of patients with acute paraquat poisoning.The initial arterial lactate clearance rate and oxygenation index have higher prognostic value. |
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