APACHE II score as a predictor of mortality following acute paraquat poisoning: A retrospective cohort study

IF 1.7 4区医学 Q3 MEDICINE, LEGAL

Journal of forensic and legal medicine Pub Date : 2026-05-01 Epub Date: 2026-04-26 DOI:10.1016/j.jflm.2026.103156

Mohan Kumar Hanumanthappa , Aarti Vaid , Saurabh C. Sharda , Ashish Behera , Valliappan Muthu , Navneet Sharma

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引用次数: 0

Abstract

Background

Paraquat poisoning carries a high mortality rate. The absence of an effective treatment and standardised prognostic tools necessitates a robust, accessible method for early risk stratification. This study aimed to evaluate whether the baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) score can predict seven-day mortality in patients with acute paraquat poisoning and distinguish survivors from non-survivors.

Methods

In this retrospective cohort study, 98 patients with confirmed paraquat poisoning admitted between January 2014 and December 2023 were included. Demographic, clinical, and laboratory data, including APACHE II scores, were extracted from medical records. Seven-day outcomes were compared using univariate and multivariable logistic regression analyses. ROC analysis was performed to assess the discriminative ability of the APACHE II score, and the optimal cut-off was determined using Youden's index.

Results

The seven-day mortality rate was 55.1% (54/98). Non-survivors exhibited significantly higher median APACHE II scores than survivors (10 vs. 8; p = 0.005). In multivariable analysis, the APACHE II score independently predicted mortality (OR, 1.16; 95% CI, 1.02–1.35; p = 0.030), along with elevated serum bilirubin levels (OR, 1.12; 95% CI, 1.02–1.24; p = 0.030). ROC analysis revealed an AUC of 0.675, and Youden's index identified an optimal APACHE II cut-off of 6.5, yielding a sensitivity of 88% and a specificity of 39.5%.

Conclusion

The baseline APACHE II score effectively and independently predicts early mortality in paraquat poisoning. However, its modest discriminative performance, particularly the low specificity of 39.5% and the retrospective design of this study are important limitations. Further prospective multicentre validation studies and integration with other clinical tools may enhance early risk stratification and support prompt clinical decision-making, particularly when specialised assays are unavailable.

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APACHE II评分作为急性百草枯中毒后死亡率的预测指标：一项回顾性队列研究。

背景：百草枯中毒死亡率高。由于缺乏有效的治疗方法和标准化的预后工具，需要一种强大的、可获得的早期风险分层方法。本研究旨在评估基线急性生理和慢性健康评估II （APACHE II）评分是否可以预测急性百草枯中毒患者的7天死亡率，并区分幸存者和非幸存者。方法：回顾性队列研究纳入2014年1月至2023年12月住院的98例确诊百草枯中毒患者。从医疗记录中提取人口统计、临床和实验室数据，包括APACHE II评分。用单变量和多变量logistic回归分析比较7天的结果。采用ROC分析评估APACHE II评分的判别能力，并采用约登指数确定最佳分界点。结果：7 d死亡率为55.1%（54/98）。非幸存者表现出明显高于幸存者的APACHE II评分中位数（10比8；p = 0.005）。在多变量分析中，APACHE II评分独立预测死亡率（OR, 1.16; 95% CI, 1.02-1.35; p = 0.030），以及血清胆红素水平升高（OR, 1.12; 95% CI, 1.02-1.24; p = 0.030）。ROC分析显示AUC为0.675，Youden指数确定最佳APACHE II截止值为6.5，敏感性为88%，特异性为39.5%。结论：基线APACHE II评分可有效独立预测百草枯中毒的早期死亡率。然而，其适度的鉴别性能，特别是39.5%的低特异性和本研究的回顾性设计是重要的局限性。进一步的前瞻性多中心验证研究和与其他临床工具的整合可能会加强早期风险分层，并支持迅速的临床决策，特别是在无法获得专门分析的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of forensic and legal medicine MEDICINE, LEGAL-

CiteScore

2.70

自引率

6.70%

发文量

106

审稿时长

57 days

期刊介绍： The Journal of Forensic and Legal Medicine publishes topical articles on aspects of forensic and legal medicine. Specifically the Journal supports research that explores the medical principles of care and forensic assessment of individuals, whether adult or child, in contact with the judicial system. It is a fully peer-review hybrid journal with a broad international perspective. The Journal accepts submissions of original research, review articles, and pertinent case studies, editorials, and commentaries in relevant areas of Forensic and Legal Medicine, Context of Practice, and Education and Training. The Journal adheres to strict publication ethical guidelines, and actively supports a culture of inclusive and representative publication.