Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department

Emergency mortality of non-trauma patients was predicted by qSOFA score

Objective

This study was aimed to evaluate the performance of quick sequential organ failure assessment (qSOFA) in predicting the emergency department (ED) mortality of non-trauma patients and to expand the application scope of qSOFA score.

Methods

A single, retrospective review of non-trauma patients was conducted in ED between November 1, 2016 and November 1, 2019. The qSOFA score was obtained from vital signs and Glasgow Coma Scale (GCS) score. The outcome was ED mortality. Multivariable logistic regression analysis was performed to explore the association between the qSOFA score and ED mortality. The area under the receiver operating characteristic (AUROC) curve, the best cutoff value, sensitivity and specificity were performed to ascertain the predictive value of the qSOFA score.

Results

228(1.96%) of the 11621 patients were died. The qSOFA score was statistically higher in the non-survival group (P<0.001). The qSOFA score 0 subgroup was used as reference baseline, after adjusting for gender and age, adjusted OR of 1, 2 and 3 subgroups were 4.77 (95%CI 3.40 to 6.70), 18.17 (95%CI 12.49 to 26.44) and 23.63 (95%CI 9.54 to 58.52). All these three subgroups show significantly higher ED mortality compared to qSOFA 0 subgroup (P<0.001). AUROC of qSOFA score was 0.76 (95% CI 0.73 to 0.79). The best cutoff value was 0, sensitivity was 77.63% (95%CI 71.7% to 82.9%), and specificity was 67.2% (95%CI 66.3% to 68.1%).

Conclusion

The qSOFA score was associated with ED mortality in non-trauma patients and showed good prognostic performance. It can be used as a general tool to evaluate non-trauma patients in ED. This is just a retrospective cohort study, a prospective or a randomized study will be required.

The use of combined high-fructose diet and glyphosate to model rats type 2 diabetes symptomatology

An ideal food-chemical combination that will promote insulin resistance and its consequent development of pancreatic beta-cell dysfunction may open a new vista for Type 2 diabetes (T2D) research. Thus, we investigated the modulatory effects of a high-fructose diet (FRC) combined with glyphosate (GP). Male albino Wistar rats were randomly divided into five groups of eight/group and received distilled water, FRC, GP, and their combinations orally for eight consecutive weeks. We assessed the changes in fasting blood glucose levels (FBGLs), biochemical indices, oxidative stress parameters, and organ histopathology. From the results obtained, FBGLs and serum insulin levels were increased in the FRC-GP (2.3-3.1 and 1.9-2.2 folds) treated rats compared with the control baseline group. Also, the FRC-GP high dose increased FBGLs (1.9 folds), insulin (1.4 folds), triglycerides (1.5 folds), and uric acid (2 folds) levels compared with the FRC group. Malondialdehyde levels increased in the pancreas (54% and 78%) and liver (31.3% and 56.6%) of the FRC-GP treated rats. The FRC-GP treatments reduced serum high-density lipoprotein (57%), total protein (47%), and antioxidant parameters (non-enzymatic and enzymatic, 1.6-1.9 folds) respectively in the treated animals. The weight of the pancreas relative to the body increased (2-3 folds) while we observed mild inflammation and vascular congestion in vital organs in the treated rats. Overall, these results demonstrate the potential of FRC-GP-diet to induce conditions of rats T2D. Also, this novel finding suggests a cost-effective GP as an alternative in this model type and provides further insight into understanding FRC-GP interactions.

Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department

Background

A prediction model of mortality for patients with acute poisoning has to consider both poisoning-related characteristics and patients’ physiological conditions; moreover, it must be applicable to patients of all ages. This study aimed to develop a scoring system for predicting in-hospital mortality of patients with acute poisoning at the emergency department (ED).

Methods

This was a retrospective analysis of the Injury Surveillance Cohort generated by the Korea Center for Disease Control and Prevention (KCDC) during 2011–2018. We developed the new-Poisoning Mortality Scoring system (new-PMS) to generate a prediction model using the derivation group (2011–2017 KCDC cohort). Points were computed for categories of each variable. The sum of these points was the new-PMS. The validation group (2018 KCDC cohort) was subjected to external temporal validation. The performance of new-PMS in predicting mortality was evaluated using area under the receiver operating characteristic curve (AUROC) for both the groups.

Results

Of 57,326 poisoning cases, 42,568 were selected. Of these, 34,352 (80.7%) and 8216 (19.3%) were enrolled in the derivation and validation groups, respectively. The new-PMS was the sum of the points for each category of 10 predictors. The possible range of the new-PMS was 0–137 points. Hosmer–Lemeshow goodness-of-fit test showed adequate calibration for the new-PMS with p values of 0.093 and 0.768 in the derivation and validation groups, respectively. AUROCs of the new-PMS were 0.941 (95% CI 0.934–0.949, p < 0.001) and 0.946 (95% CI 0.929–0.964, p < 0.001) in the derivation and validation groups, respectively. The sensitivity, specificity, and accuracy of the new-PMS (cutoff value: 49 points) were 86.4%, 87.2%, and 87.2% and 85.9%, 89.5%, and 89.4% in the derivation and validation groups, respectively.

Conclusions

We developed a new-PMS system based on demographic, poisoning-related variables, and vital signs observed among patients at the ED. The new-PMS showed good performance for predicting in-hospital mortality in both the derivation and validation groups. The probability of death increased according to the increase in the new-PMS. The new-PMS accurately predicted the probability of death for patients with acute poisoning. This could contribute to clinical decision making for patients with acute poisoning at the ED.