An early scoring system to predict mechanical ventilation for botulism: a single-center-based study

BACKGROUND: Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism. The present study aimed to establish a new scoring system to predict mechanical ventilation(MV) for botulism patients.METHODS: A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022. Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system. The area under the receiver operating characteristic(ROC) curve was calculated.RESULTS: A total of 153 patients with botulism(66 males and 87 females, with an average age of 43 years) were included. Of these, 49 patients(32.0%) required MV, including 21(13.7%) with invasive ventilation and 28(18.3%) with non-invasive ventilation. Multivariate analysis revealed that botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement were independent risk factors for MV. These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system. Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A: 1], [pneumonia: 2], [incubation period ≤1 day: 2], [hypoxia <90%: 2], [severity of muscle involvement: grade Ⅱ, 3;gradeⅢ, 7;grade IV, 11]). The scoring system achieved an area under the ROC curve of 0.82(95% CI 0.75–0.89, P<0.001). At the optimal threshold of 9, the scoring system achieved a sensitivity of 83.7% and a specificity of 70.2%.CONCLUSION: Our study identified botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement as independent risk factors for MV in botulism patients. A score ≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients. This scoring system needs to be validated externally before it can be applied in clinical settings.

Food-Borne Poisoning Accident from Amanitin Toxin in Wild Mushrooms—Xingtai City,Hebei Province,China,2023

What is already known about this topic?Fatal poisonings caused by wild mushrooms containing amanita toxins pose a significant threat in the southern regions of China.These toxins primarily induce gastrointestinal symptoms initially,which are then followed by potentially life-threatening acute liver damage.What is added by this report?This report contributes to the existing knowledge on these cases of poisoning by documenting the second occurrences in Hebei Province and the first occurrences in Xingtai City.Five individuals reported consuming wild mushrooms from the same origin,and laboratory tests confirmed the presence ofα-amanitin in their blood samples.What are the implications for public health practice?This underscores the risk associated with the collection and consumption of amanita toxin-containing mushrooms in Hebei.It is important to note that the identification of toxic and non-toxic mushrooms should not solely rely on personal experience or appearance.