Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury

AIM To identify early predictive markers of poor outcomes in patients with acute liver injury from wild mushroom intoxication.METHODS This observational, retrospective record review involved adults aged ≥ 18 years admitted to emergency department with mushroom intoxication from January 2005 to December 2015. The diagnosis of mushroom intoxication was based on the following:(1) a positive history of recent wild mushroom intake(either raw or cooked);(2) the onset of gastrointestinal symptoms, such as watery diarrhea, vomiting, and/or abdominal pain, after ingestion; and(3) the exclusion of other possible causes of acute liver injury. Acute liver injury was defined by a > 5-fold elevation of liver enzymes or moderate coagulopathy [international normalized ratio(INR) > 2.0]. Clinical and laboratory findings were compared in survivors and non-survivors.RESULTS Of 93 patients with mushroom intoxication, 23, 11 men(47.8%) and 12 women(52.2%), of median age 61 years, developed acute liver injury. The overall inhospital mortality rate was 43.5%(10/23). Among thelaboratory variables, mean serum alkaline phosphatase(73.38 ± 10.89 mg/dL vs 180.40 ± 65.39 mg/dL, P < 0.01), total bilirubin(2.312 ± 1.16 mg/dL vs 7.16 ± 2.94 mg/d L, P < 0.01) concentrations and indirect/direct bilirubin(2.45 ± 1.39 mg/dL vs 0.99 ± 0.45 mg/dL, P < 0.01) ratio as well as prothrombin time(1.88 ± 0.83 mg/dL vs 10.43 ± 4.81 mg/dL, P < 0.01), and activated partial thromboplastin time(a PTT; 32.48 ± 7.64 s vs 72.58 ± 41.29 s, P = 0.01), were significantly higher in non-survivors than in survivors. Logistic regression analysis showed that total bilirubin concentration(OR = 3.58, 95%CI: 1.25-10.22), indirect/direct bilirubin ratio(OR = 0.14, 95%CI: 0.02-0.94) and aP TT(OR = 1.30, 95%CI: 1.04-1.63) were significantly associated with mortality. All patients with total bilirubin > 5 mg/dL or aP TT > 50 s on day 3 died.CONCLUSION Monitoring of bilirubin concentrations and a PTT may help in predicting clinical outcomes in patients with acute liver injury from wild mushroom intoxication.

Prognostic value of decision criteria for emergency liver transplantation in patients with wild mushroom induced acute liver injury

Background： The reported mortality rate of mushroom-induced acute liver failure with conventionaltreatment is 1.4%–16.9%. Emergency liver transplantation may be indicated and can be the only curativetreatment option. This study aimed to assess the prognostic value of criteria for emergency livertransplantation in predicting 28-day mortality in patients with mushroom-induced acute liver injury.Methods： A retrospective cohort study was performed between January 2005 and December 2015. Alladult patients aged≥18 years admitted with mushroom intoxication at our emergency department wereevaluated. All patients with acute liver injury, defined as elevation of serum liver enzymes （〉5 timesthe upper limit of normal, ULN） or moderate coagulopathy （INR 〉 2.0） were included. The ability of the King’s College, Ganzert’s, and Escudié’s criteria to predict 28-day mortality was evaluated.