白细胞计数对急性百草枯中毒患者预后的评估价值

Evaluation value of white blood cell count for the prognosis of patients with acute paraquat poisoning

目的探讨白细胞计数(WBC)对急性百草枯(PQ)中毒患者预后的评估价值。方法回顾性分析2013年3月至2017年4月郑州大学第一附属医院急诊科收治的661例急性PQ中毒患者的临床资料,收集患者的一般资料及入院24h的生化指标。记录患者院内死亡情况并电话随访,按中毒后30d内预后分为存活组和死亡组,多因素Logistic回归分析百草枯中毒独立危险因素,并绘制受试者工作特征曲线(ROC)进行预后评价。结果在661例入选的急性PQ中毒患者中有368例(55.7%)存活,293例(44.3%)死亡。多因素Logistic回归分析结果显示住院天数、服毒剂量、中毒时间、尿PQ浓度、WBC、血钾、血肌酐(SCr)为独立危险因素。ROC曲线显示,尿PQ浓度、WBC预测急性PQ中毒患者预后的ROC曲线下面积(AUC)分别为0.897[95%CI(0.873,0.920),P<0.01]、0.876[95%CI(0.850,0.902),P<0.01]。以WBC≥15.35×10^9/L为判断预后的临界值,其判断存活的敏感度和特异度分别为72.7%和88.59%。结论白细胞计数可能是预测百草枯中毒预后强有力和简单的预测因子。

Objective To investigate the evaluation value of white blood cell count (WBC) for the prognosis of patients with acute paraquat (PQ) poisoning. Methods The clinical data of 661 patients with acute PQ poisoning admitted to the Emergency Department of the First Affiliated Hospital of Zhengzhou University from March 2013 to April 2017 were retrospectively analyzed. The general information of patients and biochemical indicators 24 hours after admission were collected. The in-hospital death were recorded and patients were followed up by telephone. According to the prognosis within 30 days after poisoning, the patients were divided into survival group and death group. Multivariate logistic regression analysis was used to analyze the independent risk factors of PQ poisoning, and the receiver operating characteristic curve (ROC) was drawn for prognosis evaluation. Results Among the 661 patients with acute PQ poisoning, 368 cases (55.7%) survived and 293 cases(44.3%) died. Multivariate logistic regression analysis showed that hospitalization days, dosage, duration of poisoning, urine PQ concentration, WBC, serum potassium and serum creatinine (Scr) were the independent risk factors. The ROC curve showed that the area under the ROC curve (AUC) of urine PQ concentration and WBC predicting the prognosis of patients with acute PQ poisoning were 0.897 [95%CI(0.873, 0.920), P<0.01], and 0.876 [95%CI(0.850, 0.902), P<0.01]. WBC≥15.35×10^9/L was used as the critical value for prognosis. The sensitivity and specificity of survival were 72.7% and 88.59%, respectively. Conclusions White blood cell count may be a powerful and simple predictor for prognosis of PQ.