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Li S, You T, Liu M, Hao Y, Li X, Wang Z, Huang F, Wang J. Dynamic changes in lactate levels within the first 24 hours in septic patients as a prognostic indicator: A retrospective cohort study utilizing latent class growth analysis. BIOMOLECULES & BIOMEDICINE 2023; 23:1118-1124. [PMID: 37485959 PMCID: PMC10655878 DOI: 10.17305/bb.2023.9259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Elevated lactate levels are common in sepsis patients. This study aimed to assess the effect of dynamic changes in lactate levels within the first 24 hours following admission on patient prognosis. We extracted data from the Medical Information Mart for Intensive Care (MIMIC)-IV database and classified patients using latent class growth analysis (LCGA). This analysis classified sepsis patients into different groups based on dynamic changes in lactate levels during the initial 24 hours post-admission, dividing this time frame into four periods (0-3 h, 3-6 h, 6-12 h, and 12-24 h). The highest lactate level recorded in each period was then used for patient classification. We subsequently compared the baseline characteristics and outcomes between these different groups. Our study encompassed 7,830 patients, whom LCGA successfully divided into two classes: class 1 (steady lactate class) and class 2 (increasing lactate class). Class 2 demonstrated a worse clinical status at baseline, as indicated by vital signs, disease severity scores, and laboratory results. Importantly, class 2 also had a significantly higher 28-day mortality rate than class 1 (55.6% vs 13.5%, P < 0.001). In conclusion, LCGA effectively categorized sepsis patients into two distinct groups based on their dynamic changes in lactate levels during the first 24 hours post-admission. This methodology has potential utility in clinical practice for managing sepsis patients.
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Affiliation(s)
- Shifeng Li
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao You
- Department of Hematopathology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Meili Liu
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yan Hao
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xinyue Li
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiyang Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fang Huang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Li S, Liang Y. Effects of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning. Biotechnol Genet Eng Rev 2023:1-13. [PMID: 37040487 DOI: 10.1080/02648725.2023.2200326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Acute poisoning is a frequently encountered medical emergency in the emergency room, typically resulting from the incorrect use of drugs or pesticides, and is characterized by sudden onset of severe symptoms, often leading to fatalities. This research was to explore the effect of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning. From August 2019 to July 2021, 137 patients with acute poisoning who received first aid process reengineering were selected as the observation group, and 151 patients with acute poisoning who received routine first aid were selected as the control group. The success rate, first aid-related indicators, electrolyte, liver function, and prognosis and survival were recorded after first aid treatment. The observation group had a 100% effective rate on the third day of first aid, which was significantly higher than the control group (91.39%). The observation group also had shorter time for emesis induction, poisoning assessment, venous transfusion, consciousness recovery, opening of the blood purification circuit, and start of hemoperfusion than the control group (P < 0.05). Additionally, the observation group showed lower levels of alpionine aminotransferase, total bilirubin, serum creatinine, and urea nitrogen after treatment, and a significantly lower mortality rate (6.57%) than the control group (26.28%) (P < 0.05). Hemoperfusion first aid process reengineering in patients with acute poisoning can improve the success rate of first aid, shorten the time of first aid, improve the electrolyte disturbance, treatment effect, liver function and blood routine of the patients.
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Affiliation(s)
- Shoupeng Li
- Department of Emergency Medicine, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, Hubei, China
| | - Yonghui Liang
- Department of Emergency and Critical Care Medicine, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
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Owusu BA, Lim A, Pongsiri N, Intawong C, Rheanpumikankit S, Suksri S, Ingviya T. Latent Trajectories of Haematological, Hepatic, and Renal Profiles after Oil Spill Exposure: A Longitudinal Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2871. [PMID: 36833568 PMCID: PMC9956276 DOI: 10.3390/ijerph20042871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/15/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) in crude oil has carcinogenic effects on various organ systems. This longitudinal cohort study examined the effects of oil spill exposure on the haematological, hepatic, and renal profiles of Rayong oil spill clean-up workers. The sample included 869 clean-up workers from the Rayong oil spill. Latent class mixture models were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices. Subgroup analysis was used to evaluate the association between the urinary metabolites of PAHs and VOCs and haematological, hepatic, and renal parameters. Most clean-up workers (97.6%) had increasing levels of white blood cells (WBCs) (0.03 × 103 cells/µL), 94.90% of the workers had a significantly increasing trend of blood urea nitrogen (0.31 mg/dL per year), and 87.20% had a significantly increasing trend of serum creatinine (0.01 mg/dL per year). A high-decreasing trend of WBCs was seen in 2.42% (-0.73 × 103 per year). Post-exposure changes in haematological, renal, and hepatic profiles are present in workers exposed to the Rayong oil spill. This indicates possible long-term health complications and worsening renal function after exposure to PAHs and VOCs in crude oil.
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Affiliation(s)
- Benjamin Atta Owusu
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani 94000, Thailand
- Multidisciplinary Research and Innovation Centre, Kumasi AOK569, Ghana
- Air Pollution and Health Effect Research Center, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani 94000, Thailand
- Air Pollution and Health Effect Research Center, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
| | - Nitinun Pongsiri
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani 94000, Thailand
- Multidisciplinary Research and Innovation Centre, Kumasi AOK569, Ghana
| | - Chanthip Intawong
- Occupational Medicine Department, Rayong Hospital, Rayong 21000, Thailand
| | | | - Saijit Suksri
- Rayong Provincial Public Health Office, Rayong 21000, Thailand
| | - Thammasin Ingviya
- Air Pollution and Health Effect Research Center, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai Campus, Songkhla 90110, Thailand
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Eizadi-Mood N, Heshmat R, Meamar R, Motamedi N. The Relative Risk of Toxico-Clinical Parameters with respect to Poisoning Severity and Outcomes in Patients with Acute Poisoning. Adv Biomed Res 2022; 11:107. [PMID: 36660757 PMCID: PMC9843600 DOI: 10.4103/abr.abr_290_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 01/21/2023] Open
Abstract
Background Complications or death risk factors is necessary for better monitoring and treatment. The aim of this study was to define the relative risk of toxico-clinical parameters with regard to poisoning severity and outcomes in patients with acute poisoning. Materials and Methods This cross-sectional study entailed of patients with acute poisoning admitted to the poisoning emergency center of khorshid hospital, Isfahan, Iran from December 2018 until March 2019. Patients (n = 300) were categorized into four groups (minor, moderate, severe, and fatal poisoning) based on severity. Multivariate logistic regression analysis was employed to calculate the odds ratio (OR) as the estimate of the relative risk of the different variables for the poisoning severity and outcomes prediction. Results In the minor group, opioids/opiates, alcohols, and benzodiazepines (14.7%) were the most prevalent poisoning, multidrug (23.3%) was in the moderate and severe groups and finally, pesticides poisoning (23%) was most common in the fatal group. The predictive factors for poisoning severity were pre-hospital antidote administration [OR, (95%CI); P value) [7.08 (1.77-28.34); 0.006]; loss of consciousness [4.38 (1.84-10.42), 0.001]; abnormal ECG [4.56 (1.65-12.56); 0.003]; and time interval of poisoning to admission in the hospital [1.15 (1.02-1.28); 0.01). Patients without complications was observed in 49.7% of subjects. Patients with the loss of consciousness [66.06 (2.41-180.07); 0.01); underlying disease [3.65 (1.09-12.24); 0.03]; abnormal respiration [1.14 (1.02-1.27); 0.02); have had a greater risk of complications and death. Conclusion Important factors for poisoning severity and/or outcome were loss of consciousness, pre-hospital antidote administration, abnormal ECG or respiration, underlying disease, and delay to presentation to hospital.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasol Heshmat
- Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Rokhsareh Meamar, Isfahan Clinical Toxicology Research Center, Khorshid Hospital, Ostandari Street, Hasht Behest Avenue, Postal Code: 81458-31451, Isfahan, Iran. E-mail:
| | - Narges Motamedi
- Department of Preventive and Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Farooqui WA, Uddin M, Qadeer R, Shafique K. Latent class trajectories of biochemical parameters and their relationship with risk of mortality in ICU among acute organophosphorus poisoning patients. Sci Rep 2022; 12:11633. [PMID: 35804092 PMCID: PMC9270430 DOI: 10.1038/s41598-022-15973-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
Acute poisoning is a global public health challenge. Several factors played role in high mortality among acute organophosphorus poisoning (OP) poisoning patients including clinical, vitals, and biochemical properties. The traditional analysis techniques use baseline measurements whereas latent profile analysis is a person-centered approach using repeated measurements. To determine varying biochemical parameters and their relationship with intensive care unit (ICU) mortality among acute organophosphorus poisoning patients through a latent class trajectory analysis. The study design was a retrospective cohort and we enrolled data of 299 patients admitted between Aug’10 to Sep’16 to ICU of Dr. Ruth K. M. Pfau, Civil Hospital, Karachi. The dependent variable was ICU-mortality among OP poisoning patients accounting for ICU stay, elapsed time since poison ingestion, age, gender, and biochemical parameters (including electrolytes (potassium, chloride, sodium), creatinine, urea, and random blood sugar). Longitudinal latent profile analysis is used to form the trajectories of parameters. In determining and comparing the risk of ICU-mortality we used Cox-Proportional-Hazards models, repeated measures and trajectories were used as independent variables. The patients’ mean age was 25.4 ± 9.7 years and ICU-mortality was (13.7%, n = 41). In trajectory analysis, patients with trajectories (normal-increasing and high-declining creatinine, high-remitting sodium, normal-increasing, and high-remitting urea) observed the highest ICU-mortality i.e. 75% (6/8), 67% (2/3), 80% (4/5), 75% (6/8), and 67% (2/3) respectively compared with other trajectories. On multivariable analysis, compared with patients who had normal consistent creatinine levels, patients in normal-increasing creatinine class were 15 times [HR:15.2, 95% CI 4.2–54.6], and the high-declining class was 16-times [HR 15.7, 95% CI 3.4–71.6], more likely to die. Patients in with high-remitting sodium, the trajectory was six-times [HR 5.6, 95% CI 2.0–15.8], normal-increasing urea trajectory was four times [HR 3.9, 95% CI 1.4–11.5], and in extremely high-remitting urea trajectory was 15-times [HR 15.4, 95% CI 3.4–69.7], more likely to die compared with those who were in normal-consistent trajectories of sodium and urea respectively. Among OP poisoning patients an increased risk of ICU-mortality were significantly associated with biochemical parameters (sodium, urea, creatinine levels) using latent profile technique.
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Affiliation(s)
- Waqas Ahmed Farooqui
- School of Public Health, Dow University of Health Sciences, 2nd Floor, Nursing Building, Ojha Campus, Gulzar-e-Hijri, Zohra Nagar, Scheme 33, Karachi City, Sindh, Pakistan.
| | - Mudassir Uddin
- Department of Statistics, University of Karachi, Karachi, Pakistan
| | - Rashid Qadeer
- Department of Medicine, Ruth Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, 2nd Floor, Nursing Building, Ojha Campus, Gulzar-e-Hijri, Zohra Nagar, Scheme 33, Karachi City, Sindh, Pakistan.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Mu Y, Hu B, Gao N, Pang L. Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning. Open Life Sci 2021; 16:703-710. [PMID: 34307885 PMCID: PMC8284330 DOI: 10.1515/biol-2021-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/15/2022] Open
Abstract
This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups - good and poor - based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10-1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03-1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74-0.824] and 0.714 [95% CI, 0.626-0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.
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Affiliation(s)
- Yuhang Mu
- Department of Emergency, First Hospital of Jilin University, No. 1 Xinmin Road, Changchun, 130021, China
| | - Boqi Hu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Nan Gao
- Department of Emergency, Third Clinical Hospital of Changchun Traditional Chinese Medicine University, Changchun, 130117, China
| | - Li Pang
- Department of Emergency, First Hospital of Jilin University, No. 1 Xinmin Road, Changchun, 130021, China
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Noghrehchi F, Dawson AH, Raubenheimer JE, Buckley NA. Role of age-sex as underlying risk factors for death in acute pesticide self-poisoning: a prospective cohort study. Clin Toxicol (Phila) 2021; 60:184-190. [PMID: 34032543 DOI: 10.1080/15563650.2021.1921186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is growing evidence in the literature that patients' age is associated with increased risk of death in acute pesticide poisoning. However, few studies have investigated whether the age effect differs between males and females. We aimed to examine the association between age-sex and risk of death in acute pesticide self-poisoning. METHODS A prospective cohort of deliberate pesticide-poisoned patients admitted to ten rural Sri Lankan hospitals between March 2002 and December 2019. The pesticide ingested was identified based on identification of container or history. A mixed effects logistic regression was fitted to investigate the effect of age-sex on death in acute pesticide self-poisoning adjusting for clinical symptoms on admission, measured by Glasgow Coma Scale and Poison Severity Score, and controlling for clustering among hospital sites. RESULTS In total, 201 different pesticides were ingested by patients. 6,643 patients ingested an unknown pesticide. A single pesticide was co-ingested with alcohol by 4,603 patients. Of the 28,303 patients enrolled, 2,028 patients died, resulting in case fatality of 7.2% (95% CI 6.9-7.5). The effect of age on case fatality was stronger for males after 21 years of age. The odds of dying for each 5 years increase in age was 1.26 (95% CI 1.23-1.28) times higher for males versus 1.14 (95% CI 1.10-1.19) times higher for females. Missing data were handled by multiple imputation. CONCLUSION Patient's age-sex are important risk factors for death in acute pesticide self-poisoning even after controlling for clinical effects. The age effect on the odds of dying was significantly different for males and females, with this effect being stronger for males. Given that patient's age and sex are very easy to collect on admission, our study highlights the need for incorporating these risk factors in policy and clinical decisions.
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Affiliation(s)
- Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew H Dawson
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - Jacques E Raubenheimer
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
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