Pneumomediastinum predicts early mortality in acute paraquat poisoning

Chun Yu Zhou, Xin Kang, Chang Bin Li, Xin Hua Li, Yong Liu, Zhen Wang, Ling Wang, Tianfu Wu, Chandra Mohan, Da Yong Hu, Ai Peng

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Context. 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. Objective. We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. Materials and methods. Enrolled PQ-poisoned patients (n = 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. Results. 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 (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). Discussion and conclusion. Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalClinical Toxicology
Volume53
Issue number6
DOIs
StatePublished - Jul 1 2015

Fingerprint

Mediastinal Emphysema
Paraquat
Poisoning
Mortality
Hazards
Poisons
Physiology
Regression analysis
Tomography
Health
Confidence Intervals
Chemical and Drug Induced Liver Injury
APACHE
Acute Kidney Injury
Respiratory Insufficiency

Keywords

  • Computed tomography
  • Mortality
  • Paraquat
  • Pneumomediastinum

ASJC Scopus subject areas

  • Toxicology

Cite this

Zhou, C. Y., Kang, X., Li, C. B., Li, X. H., Liu, Y., Wang, Z., ... Peng, A. (2015). Pneumomediastinum predicts early mortality in acute paraquat poisoning. Clinical Toxicology, 53(6), 551-556. https://doi.org/10.3109/15563650.2015.1046183

Pneumomediastinum predicts early mortality in acute paraquat poisoning. / 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.

In: Clinical Toxicology, Vol. 53, No. 6, 01.07.2015, p. 551-556.

Research output: Contribution to journalArticle

Zhou, CY, Kang, X, Li, CB, Li, XH, Liu, Y, Wang, Z, Wang, L, Wu, T, Mohan, C, Hu, DY & Peng, A 2015, 'Pneumomediastinum predicts early mortality in acute paraquat poisoning', Clinical Toxicology, vol. 53, no. 6, pp. 551-556. https://doi.org/10.3109/15563650.2015.1046183
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. / Pneumomediastinum predicts early mortality in acute paraquat poisoning. In: Clinical Toxicology. 2015 ; Vol. 53, No. 6. pp. 551-556.
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abstract = "Context. 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. Objective. We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. Materials and methods. Enrolled PQ-poisoned patients (n = 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. Results. 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 (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8{\%} of patients with PM vs. 40.7{\%} among those without PM; hazard ratio [HR], 2.4; 95{\%} confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3{\%} vs. 27.1{\%}; HR, 3.2; 95{\%} CI, 1.2-8.1; P = 0.017). Discussion and conclusion. Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.",
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T1 - Pneumomediastinum predicts early mortality in acute paraquat poisoning

AU - Zhou, Chun Yu

AU - Kang, Xin

AU - Li, Chang Bin

AU - Li, Xin Hua

AU - Liu, Yong

AU - Wang, Zhen

AU - Wang, Ling

AU - Wu, Tianfu

AU - Mohan, Chandra

AU - Hu, Da Yong

AU - Peng, Ai

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N2 - Context. 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. Objective. We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. Materials and methods. Enrolled PQ-poisoned patients (n = 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. Results. 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 (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). Discussion and conclusion. Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.

AB - Context. 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. Objective. We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. Materials and methods. Enrolled PQ-poisoned patients (n = 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. Results. 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 (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). Discussion and conclusion. Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.

KW - Computed tomography

KW - Mortality

KW - Paraquat

KW - Pneumomediastinum

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