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Predictors of acute kidney injury after paraquat intoxication
#MMPMID28881652
Weng CH
; Chen HH
; Hu CC
; Huang WH
; Hsu CW
; Fu JF
; Lin WR
; Wang IK
; Yen TH
Oncotarget
2017[Aug]; 8
(31
): 51345-51354
PMID28881652
show ga
Paraquat intoxication is characterized by multi-organ failure, causing
substantial mortality and morbidity. Many paraquat patients experience acute
kidney injury (AKI), sometimes requiring hemodialysis. We observed 222
paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n
= 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than
non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer
time to hospital arrival (P = 0.003), lower PaO(2) (P = 0.006) and higher
alveolar-arterial O(2) difference (P < 0.001) 48 h after admission, higher
sequential organ failure assessment 48-h score (P < 0.001), higher severity index
of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO(2) at admission (P =
0.031), higher PaO(2) at admission (P = 0.015), lower nadir PaCO(2) (P = 0.001)
and lower nadir HCO(3) (P = 0.004) than non-AKI patients. Multivariate logistic
regression indicated that acute hepatitis (P < 0.001), a longer time to hospital
arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO(2) at admission
(P = 0.014) were predictors of AKI. The area under the receiver operating
characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score
? 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and
specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and
acute hepatitis, the time to hospital arrival, SIPP score and PaO(2) at admission
were powerful predictors of AKI. Larger studies with longer follow-up durations
are warranted.