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.

Probabilistic Distribution of the Maximum Wave Heigh

A new method of treating maximum wave height as a random variable in reliability analysis of breakwater caissons isproposed. The maximum wave height is expressed as the significant wave height multiplied by the so-called wave height ratio.The proposed wave height ratio is a type of transfer function from the significant wave height to the maximum wave height.Under the condition of a breaking wave, the ratio is intrinsically nonlinear. Therefore, the probability density function for thevariable cannot be easily defined. In this study, however, it can be derived from the relationship between the maximum andsignificant waves in a nonbreaking environment. Some examples are shown to validate the derived probability density functionfor the wave ratio parameter. By introducing the wave height ratio into reliability analysis of caisson breakwater, the maximumwave height can be used as an independent and primary random variable, which means that the risk of caisson failure during itslifetime can be evaluated realistically.