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| The value of white blood cell count and arterial blood lactate level in prognosis evaluation of patients with acute paraquat poisoning |
| Ge Xin, Fu Hong-na, Chen Xin, Sun Zhao-rui, Bai Xiao-cui, Yang Zhi-zhou, Nie Shi-nan |
| Department of Emergency Medicine, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, China |
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Abstract Objective To analyze the relationship between early white blood cell count (WBC) or arterial blood lactate (Lac) and recent survival of patients with paraquat poisoning, estimating their prognostic value in these patients. Methods The clinical data of patients with acute paraquat poisoning who were admitted to Department of Emergency Medicine, Jinling Hospital, from Jan 2015 to May 2018 were retrospectively analyzed. Patients were divided into death or survival group based on their living status of the 28th days after poisoning. The WBC（20.20×109/L vs.9.00×109/L）, Lac(7.50 mmol/L vs. 0.90 mmol/L), other clinical laboratory indicators and related data were statistically analyzed in the two groups. Longistic regression and ROC curves were used to evaluate the predictive value of WBC, Lac and the combination of the two indicators in the prognosis of patients with paraquat poisoning. Results Sixty-two patients with acute paraquat poisoning were enrolled, 27 survived, 35 died, and the mortality rate was 56%. The WBC and Lac in the death group were significantly higher than the survival group ( P < 0.05). Moreover, multivariate Longistic regression showed WBC ［regression coefficient=0.193, OR =1.213, 95% CI ( 1.021 -1.441), P <0.05］, Lac［regression coefficient=0.492, OR=1.635, 95% CI (1.102- 2.428 ), P <0.05］ are independent risk factors in patients with paraquat poisoning. The area under (AUC) the ROC curve of white blood cell count was 0.874 (95% CI 0.788-0.959), the maximum Youden index was 0.607, and the optimal cut-off value was 12.1×109/L. AUC of arterial blood lactate was 0.898 (95% CI 0.824-0.972), the maximum Youden index was 0.644, and the optimal cut-off value was 2.1 mmol/L; the area under the ROC curve of combining the two indicators is 0.922 (95% CI 0.851-0.993). With AUC>0.8 as the standard, the above parameters are effective indicators for evaluating the prognosis of death in patients with paraquat poisoning. Conclusion Early WBC and Lac are independent risk factors associated with prognosis in patients with acute paraquat poisoning. The combination of the two parameters predicts the prognosis of patients with acute paraquat poisoning well, which is expected to be used for clinical monitoring and prognosis evaluation of patients with paraquat poisoning.
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Corresponding Authors:
Nie Shi-nan, E-mail: shn_nie@sina.com
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