Pneumomediastinum predicts early mortality in acute paraquat poisoning. (July 2015)

• Record Type: Journal Article
• Authors: Zhou, Chun-Yu; Kang, Xin; Li, Chang-Bin; Li, Xin-Hua; Liu, Yong; Wang, Zhen; Wang, Ling; Wu, Tianfu; Mohan, Chandra; Hu, Da-Yong; Peng, Ai
• Is Part Of: Clinical toxicology. Volume 53:Number 6(2015)
• Page Start: 551
• Page End: 556
• Publication Date: 2015-07
• Subjects: Toxicology -- Periodicals; Toxicological emergencies -- Periodicals; 615.9
• DOI: 10.3109/15563650.2015.1046183
• Languages: English
• ISSNs: 1556-3650

Abstract

<abstract> <title>Abstract</title> <p> <italic>Context.</italic> In paraquat (PQ) poisoning, death often occurs after the appearance of pneumomediastinum (PM). However, the clinical features and eventual outcome of PM in PQ intoxication remains unclear. <italic>Objective</italic>. We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. <italic>Materials and methods.</italic> Enrolled PQ-poisoned patients (<italic>n</italic> = 75) were divided into two groups according to whether PM could be detected by chest computed tomography or not. The study outcomes included 5- and 90-day death after intoxication. Survival curves were derived using the Kaplan–Meier method, and mortality risk factors were analyzed by forward stepwise Cox regression analysis. <italic>Results.</italic> PM was documented in 21.3% of the patients (16/75); in 13 of them PM set in within 3 days of PQ ingestion. 15 patients died within 3 days of appearance of PM. Compared with patients without PM, those with PM were younger (<italic>P</italic> = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (<italic>P</italic> < 0.001) and Sequential Organ Failure Assessment (<italic>P</italic> = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (<italic>P</italic> = 0.001), toxic hepatitis (<italic>P</italic> = 0.008), and respiratory insufficiency (<italic>P</italic> = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM <italic>vs.</italic> 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0–5.6; <italic>P</italic> = 0.045), and increased risk of 5-day death (81.3% <italic>vs.</italic> 27.1%; HR, 3.2; 95% CI, 1.2–8.1; <italic>P</italic> = 0.017). <italic>Discussion and conclusion.</italic> Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.</p> </abstract>