Prognostic value of initial arterial lactate and 6-h lactate clearance rate in acute paraquat poisoning / 中华急诊医学杂志

ABSTRACT

Objective To investigate the correlation of the initial arterial lactate (Lac) and 6-h lactate clearance rate (LCR) with prognosis in patients with acute paraquat poisoning (APP).Methods The included 132 APP patients (70 males and 62 females,age ranging 15-71,30 (18) [M (IQR)]treated at a single center between January 2009 and December 2013.Patients were divided into two groups:group A,survivors ＞ 28 days after admission (n =64); and group B,those died ≤ 28 days after admission (n =68).The prognostic values of arterial Lac and 6-h LCR during the acute stage of poisoning were evaluated.Results Paraquat dose ranged from 5-200 mL,20 mL (37.25 mL) [M (IQR)].The average time from poisoning to arrival at the emergency department was ranging 4-312 h,6 h (8.75h) [M (IQR)].Total mortality was 51.51％.There were no differences in age,gender,and length of time elapsed from poisoning to diagnosis between two groups.Survivors had a significantly lower dose of paraquat ingested compared with nonsurvivors (P ＜ 0.05).An ROC curve analysis determined that the dose had an area of 0.86 (95％ CI:0.80-0.92) and the volume cut-off point was 27.5 mL to predict the prognosis in patients with acute paraquat poisoning (75％ sensitivity,85.9％ specificity,Youden index 0.609).The initial arterial lactate level was higher in nonsurvivors than that in survivors.The ROC curve analysis indicated that the initial arterial lactate level had an area of 0.99 (95％ CI:0.99-1.00) and the concentration cut-off point was 5.050 mmoL/L to predicti prognosis in patients with acute paraquat poisoning (sensitivity 98.5％,specificity 100％,Youden index 0.985).The 6 h LCR was lower in nonsurvivors than that in survivors.ROC curve analysis showed that the 6-h LCR had an area of 0.99 (95 ％ CI:0.97-1.00) and the concentration cut-off point was 17.28％ to predict prognosis in APP patients (sensitivity 100％,specificity 97.1％,Youden index 0.971).Conclusions In the early stages of APP,initial arterial Lac and 6-h LCR are closely related to prognosis and may serve as prognostic factors.