Predictors of acute respiratory distress syndrome in patients with paraquat intoxication

Cheng-Hao Weng; Ching-Chih Hu; Ja-Liang Lin; Dan-Tzu Lin-Tan; Ching-Wei Hsu; Tzung-Hai Yen

doi:10.1371/journal.pone.0082695

Predictors of acute respiratory distress syndrome in patients with paraquat intoxication

PLoS One. 2013 Dec 11;8(12):e82695. doi: 10.1371/journal.pone.0082695. eCollection 2013.

Authors

Cheng-Hao Weng¹, Ching-Chih Hu², Ja-Liang Lin¹, Dan-Tzu Lin-Tan¹, Ching-Wei Hsu¹, Tzung-Hai Yen¹

Affiliations

¹ Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
² Chang Gung University, College of Medicine, Taoyuan, Taiwan ; Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan.

Abstract

Introduction: Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters.

Materials and methods: In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed.

Results: The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN48-h scores (P<0.009), SOFA48-h scores (P<0.001), and time to ARDS/nadir PaO2 (P=0.008) but also suffered from lower nadir PaO2 (P<0.001), nadir AaDO2 (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA48-h scores <3 and SOFA48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS.

Conclusions: The analytical results indicate that SOFA48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Herbicides / poisoning*
Humans
Male
Middle Aged
Paraquat / poisoning*
Prognosis
Respiratory Distress Syndrome / chemically induced*
Respiratory Distress Syndrome / diagnosis*
Respiratory Distress Syndrome / mortality
Retrospective Studies

Substances

Herbicides
Paraquat

Grants and funding

Cheng-Hao Weng was funded by research grants from the Chang Gung Memorial Hospital (CMRPG391161). Tzung-Hai Yen was funded by research grants from the Chang Gung Memorial Hospital (CMRG3C0771) and National Science Council of Taiwan (NSC 102-2314-B-182 -044-). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.