Prediction of the development of acute liver injury in mushroom poisoning by hemogram parameters

Introduction: Predicting acute liver damage caused by mushroom poisoning from hemogram parameters at first admission to hospital. Methods: This retrospective study involved adults ≥18 years old who presented to the emergency room with mushroom poisoning from January 2011 to January 2017. Diagnosis of mushroom poisoning was made by a recent history of eating mushrooms, the onset of gastrointestinal symptoms such as diarrhea, vomiting, or abdominal pain after eating mushrooms, and excluding other possible causes of acute liver damage. Acute liver injury was defined as a 5-fold or greater increase in liver enzymes or the development of moderate coagulopathy (international normalized ratio > 2.0). First admission hemogram parameters of those who had liver damage and those who did not develop liver damage in the emergency department were compared. Results: Acute liver injury developed in ten of 136 patients (68 women (50%), 68 men (50%), and mean age 39.5 years) included in the study. Three of them died (in-hospital mortality – 30% and mushroom poisoning overall mortality – 2.2%). Among the hemogram parameters, hemoglobin (13.9±1.7 g/dL vs. 15.4±1.7 g/dL, p=0.013), mean platelet volume (MPV) (7.6±1.02 fl versus 8.8±1.1 fl, p<0.05), and red cell distribution width (RDW) (16.5±4.8% vs 24.3±13.7%, p=0.034) in those who developed acute liver injury were significantly higher than those that did not develop. Discussion and Conclusion: The high levels of MPV and RDW in the hemogram examination of the patients presented to the emergency department with mushroom poisoning may help to predict the progression of acute liver injury.