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Objective: This study aimed to access the prognostic significance of urine paraquat (PQ) concentrations in patients with acute PQ poisoning.Methods: From January 2009 to December 2012, a total of 306 patients with acute PQ poisoning were adnmitted to the Emergency Intensive Care Unit (EICU) at the First Affiliated Hospital of China Medical University.The relationships between urine PQ concentrations and prognosis of patients with acute PQ poisoning were evaluated.Results:The mean ingested PQ dose of patients with acute PQ poisoning was 36.9 ± 11.4 ml.The mean time interval between paraquat ingestion and presentation for medical care was 4.8 ± 1.2 h.The overall mortality rate was 70.9% (217/306) during a 28-day follow-up period.According to clinical outcomes within 28 days after PQ poisoning, all patients were divided in to the survivor group (n =89) and the non-survivor group (n =217).There were 38 patients died within 7 days after PQ poisoning, and 179 patients died within 7 ~28 days.There was a significant difference in initial urine PQ concentrations between nonsurvivors and survivors (P =0.029).The initial urine PQ concentrations of patients died within 7 days after PQ poisoning were also higher than those of other patients (P =0.031).The mortality rate of patients with urine PQ concentration≤ 50 μg/ml was significantly lower than those with urine PQ concentration > 50 pg/ml (P < 0.001).In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve (AUC) of initial urine PQ concentrations for predicting mortality was 0.804 with a cut-off value of 49.8 g/ml; while the AUC of initial urine PQ concentrations for predicting mortality within 7 days was 0.896 with a cut-off value of 97.5 g/ml.Conclusion: The initial urine PQ concentrations had good predictive powers for evaluating the prognosis of patients with acute PQ poisoning.Thus, urine PQ concentration may serve as a useful biomarker for assessing the severity of acute PQ poisoning.