Heba K. Khalifa, Wafaa M. Masoud, Alshaimma Mahmoud Elmansy
{"title":"动脉血气和血清皮质醇水平作为急性磷化铝中毒患者死亡率的预测因子:一项前瞻性队列研究。","authors":"Heba K. Khalifa, Wafaa M. Masoud, Alshaimma Mahmoud Elmansy","doi":"10.1016/j.toxrep.2024.101865","DOIUrl":null,"url":null,"abstract":"<div><div>Aluminum phosphide (ALP) is an extremely toxic substance that causes significant morbidity and mortality. Early identification of patients at risk could improve their outcomes. Therefore, this study evaluated the role of serial arterial blood gases and serum cortisol levels in predicting outcomes in patients with acute ALP poisoning. This prospective cohort study included sixty ALP-poisoned patients. Arterial blood gases and serum cortisol levels were assessed at the time of hospital admission, at 6 hours, and at 12 hours after hospital admission. The mortality rate was 55 %. At the time of hospital admission, non-survivors had significantly lower blood pH (7.36 ± 0.08 vs. 7.31 ± 0.09, p = 0.025), reduced bicarbonate values (15.67 ± 4.72 vs. 11.44 ± 3.05 mEq/L, p = 0.001) and higher serum cortisol levels (41.83 ± 15.93 vs. 58.41 ± 19.61 μg/dL, p = 0.002) compared to the survivors. A receiver-operating characteristic (ROC) analysis for the prediction of mortality indicates that the area under the curve (AUC) of blood pH is 0.712 at a cut-off value of ≤ 7.34, with a sensitivity of 75.76 % and a specificity of 66.67 %. At a cut-off value of ≤ 13.5 mEq/L, the AUC of bicarbonate was 0.777, with a sensitivity of 75.76 % and a specificity of 66.67 %. The serum cortisol level exhibited an AUC of 0.737 at a cut-off level of > 45.5 μg/dL, with a sensitivity of 69.70 % and a specificity of 67 %. Therefore, it can be posited that low arterial pH, bicarbonate values, and elevated cortisol levels can predict mortality in acutely poisoned patients with ALP.</div></div>","PeriodicalId":23129,"journal":{"name":"Toxicology Reports","volume":"14 ","pages":"Article 101865"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718342/pdf/","citationCount":"0","resultStr":"{\"title\":\"Arterial blood gases and serum cortisol level as predictors for mortality in acute aluminum phosphide poisoned patients: A prospective cohort study\",\"authors\":\"Heba K. Khalifa, Wafaa M. Masoud, Alshaimma Mahmoud Elmansy\",\"doi\":\"10.1016/j.toxrep.2024.101865\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Aluminum phosphide (ALP) is an extremely toxic substance that causes significant morbidity and mortality. Early identification of patients at risk could improve their outcomes. Therefore, this study evaluated the role of serial arterial blood gases and serum cortisol levels in predicting outcomes in patients with acute ALP poisoning. This prospective cohort study included sixty ALP-poisoned patients. Arterial blood gases and serum cortisol levels were assessed at the time of hospital admission, at 6 hours, and at 12 hours after hospital admission. The mortality rate was 55 %. At the time of hospital admission, non-survivors had significantly lower blood pH (7.36 ± 0.08 vs. 7.31 ± 0.09, p = 0.025), reduced bicarbonate values (15.67 ± 4.72 vs. 11.44 ± 3.05 mEq/L, p = 0.001) and higher serum cortisol levels (41.83 ± 15.93 vs. 58.41 ± 19.61 μg/dL, p = 0.002) compared to the survivors. A receiver-operating characteristic (ROC) analysis for the prediction of mortality indicates that the area under the curve (AUC) of blood pH is 0.712 at a cut-off value of ≤ 7.34, with a sensitivity of 75.76 % and a specificity of 66.67 %. At a cut-off value of ≤ 13.5 mEq/L, the AUC of bicarbonate was 0.777, with a sensitivity of 75.76 % and a specificity of 66.67 %. The serum cortisol level exhibited an AUC of 0.737 at a cut-off level of > 45.5 μg/dL, with a sensitivity of 69.70 % and a specificity of 67 %. Therefore, it can be posited that low arterial pH, bicarbonate values, and elevated cortisol levels can predict mortality in acutely poisoned patients with ALP.</div></div>\",\"PeriodicalId\":23129,\"journal\":{\"name\":\"Toxicology Reports\",\"volume\":\"14 \",\"pages\":\"Article 101865\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718342/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Toxicology Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2214750024002488\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Environmental Science\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Toxicology Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214750024002488","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Environmental Science","Score":null,"Total":0}
引用次数: 0
摘要
磷化铝(ALP)是一种剧毒物质,可引起严重的发病率和死亡率。早期识别有风险的患者可以改善他们的预后。因此,本研究评估了系列动脉血气和血清皮质醇水平在预测急性ALP中毒患者预后中的作用。这项前瞻性队列研究包括60例alp中毒患者。在入院时、入院后6 小时和入院后12 小时评估动脉血气和血清皮质醇水平。死亡率为55 %。住院的时候,non-survivors显著降低血液pH值(7.36 ±0.08 vs 7.31 ± 0.09,p = 0.025),降低碳酸氢值(15.67 ±4.72 vs 11.44 ± 3.05毫克当量/ L p = 0.001)和更高的血清皮质醇水平(41.83 ± 15.93和58.41±19.61 μg / dL, p = 0.002)相比,幸存者。预测死亡率的受试者工作特征(ROC)分析表明,血pH曲线下面积(AUC)为0.712,临界值≤ 7.34,敏感性为75.76 %,特异性为66.67 %。截断值≤ 13.5 mEq/L时,碳酸氢盐的AUC为0.777,敏感性为75.76 %,特异性为66.67 %。血清皮质醇水平的AUC为0.737,截断水平为> 45.5 μg/dL,敏感性为69.70 %,特异性为67 %。因此,可以假设动脉pH值、碳酸氢盐值和皮质醇水平升高可以预测急性中毒ALP患者的死亡率。
Arterial blood gases and serum cortisol level as predictors for mortality in acute aluminum phosphide poisoned patients: A prospective cohort study
Aluminum phosphide (ALP) is an extremely toxic substance that causes significant morbidity and mortality. Early identification of patients at risk could improve their outcomes. Therefore, this study evaluated the role of serial arterial blood gases and serum cortisol levels in predicting outcomes in patients with acute ALP poisoning. This prospective cohort study included sixty ALP-poisoned patients. Arterial blood gases and serum cortisol levels were assessed at the time of hospital admission, at 6 hours, and at 12 hours after hospital admission. The mortality rate was 55 %. At the time of hospital admission, non-survivors had significantly lower blood pH (7.36 ± 0.08 vs. 7.31 ± 0.09, p = 0.025), reduced bicarbonate values (15.67 ± 4.72 vs. 11.44 ± 3.05 mEq/L, p = 0.001) and higher serum cortisol levels (41.83 ± 15.93 vs. 58.41 ± 19.61 μg/dL, p = 0.002) compared to the survivors. A receiver-operating characteristic (ROC) analysis for the prediction of mortality indicates that the area under the curve (AUC) of blood pH is 0.712 at a cut-off value of ≤ 7.34, with a sensitivity of 75.76 % and a specificity of 66.67 %. At a cut-off value of ≤ 13.5 mEq/L, the AUC of bicarbonate was 0.777, with a sensitivity of 75.76 % and a specificity of 66.67 %. The serum cortisol level exhibited an AUC of 0.737 at a cut-off level of > 45.5 μg/dL, with a sensitivity of 69.70 % and a specificity of 67 %. Therefore, it can be posited that low arterial pH, bicarbonate values, and elevated cortisol levels can predict mortality in acutely poisoned patients with ALP.