BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patient...BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit(ICU).METHODS: In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs(total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included.RESULTS: In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS Ⅱ, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy(P=0.04; OR=1.06; 95%CI=1.05–1.08; cut-off=42 μg/d L; sensitivity=70%; specificity=82%). Between aluminium phosphide(ALP)-and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning(all Ps<0.001 in both uni and multivariate analyses). Median(interquartile range; IQR) GCS was 7(6, 10) and 15(8, 15) in non-ALP and ALP-poisoned patients(P<0.003). SAPS Ⅱ and APACHE Ⅱ could not prognosticate death at all.CONCLUSION: Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.展开更多
BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may f...BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute Al P poisoning to evaluate its role as a prognostic factor.METHODS: This was a prospective study on acute Al P intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a selfmade questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.RESULTS: Thirty-nine(27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood p H and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was signifi cantly higher in the non-survivors group during 8 to 16 hours post ingestion.CONCLUSION: Blood lactate level could be used as an index of severity of acute Al P poisoning.展开更多
文摘BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit(ICU).METHODS: In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs(total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included.RESULTS: In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS Ⅱ, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy(P=0.04; OR=1.06; 95%CI=1.05–1.08; cut-off=42 μg/d L; sensitivity=70%; specificity=82%). Between aluminium phosphide(ALP)-and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning(all Ps<0.001 in both uni and multivariate analyses). Median(interquartile range; IQR) GCS was 7(6, 10) and 15(8, 15) in non-ALP and ALP-poisoned patients(P<0.003). SAPS Ⅱ and APACHE Ⅱ could not prognosticate death at all.CONCLUSION: Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.
基金supported by a grant from Toxicological Research Center of Shahid Beheshti University of Medical Sciences
文摘BACKGROUND: Aluminum phosphide(Al P) poisoning is common in the developing countries. There is no specifi c antidote for the treatment of acute Al P poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute Al P poisoning to evaluate its role as a prognostic factor.METHODS: This was a prospective study on acute Al P intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a selfmade questionnaire. Blood lactate levels were analyzed every two hours for 24 hours.RESULTS: Thirty-nine(27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood p H and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was signifi cantly higher in the non-survivors group during 8 to 16 hours post ingestion.CONCLUSION: Blood lactate level could be used as an index of severity of acute Al P poisoning.
