Original Contribution
The early prognostic factors of glyphosate-surfactant intoxication

https://doi.org/10.1016/j.ajem.2007.05.011Get rights and content

Abstract

Background and Purpose

The purpose of this study was to establish an early prognostic model of patients with glyphosate-surfactant (GlySH) herbicide intoxication.

Methods

A case-control study was conducted. Data of GlySH-intoxicated patients were collected from 2 hospitals. Patients were admitted to the emergency departments (EDs) of Chang Gung Memorial Hospital from April 1996 to March 2003 and Taichung Veterans General Hospital from April 2000 to October 2003. Collected variables such as age, sex, estimated amount of ingestion, symptoms/signs including first vital signs, chest x-ray (CXR), and biochemical studies were analyzed for their role in the prognostic model of GlySH intoxication mortality. Univariate and odds ratio analyses were then performed. The prognostic model was then established by using logistic regression analysis and further stratified analysis.

Results

Fifty-eight patients (19 men and 39 women; age, 48.8 ± 15.8 years; P = .38) were enrolled in our study. Forty-one patients survived from GlySH intoxication and 17 died. After univariate analysis, 5 variables (respiratory distress needing intubation, metabolic acidosis, tachycardia, elevated creatinine (Cr) level, and hyperkalemia) were found to be highly associated with poor outcome and mortality. Then a multiple logistic regression model was established as follows: log(p/q) = −6.13 + 3.43 (abnormal CXR) + 2.53 (metabolic acidosis) + 2.55 (Cr) + 2.4 (tachycardia) + e.

Conclusion

GlySH poisoning is multiorgan toxicity. Pulmonary toxicity and renal toxicity seem to be responsible for its mortality. Metabolic acidosis, abnormal CXR, tachycardia, and elevated Cr level are useful prognostic factors for predicting GlySH mortality.

Introduction

Glyphosate-surfactant (GlySH) is one of the commonly used herbicides and GlySH poisoning had been reported [1], [2], [3], [4], [5]. The toxic syndrome of GlySH was proposed as gastrointestinal irritation, dysfunction of hepatorenal system, and more severe, pulmonary toxicity and cardiovascular system instability [1], [2], [3], [4], [5]. The cause of death after GlySH poisoning remains a controversial issue. Some authors believed it is due to pulmonary toxicity, such as pulmonary edema and/or aspiration pneumonitis, whereas others think cardiogenic and/or hypotensive shock is the cause of death [1], [2], [5], [6], [7]. A prognostic model not only plays a critical role in assessing the severity of poisoning in GlySH-intoxicated patients, but also helps in the management of such kinds of patients. Furthermore, the assay of the prognostic factors may give us a clue as to the cause of death of GlySH-intoxicated patients. At present, one prognostic model has been proposed. However, it is an unstable one [5]. Other authors reported some prognostic factors but they were not early predictors [6], [8]. The purpose of this study was to establish an early prognostic model of GlySH-intoxicated patients.

Section snippets

Methods

This was a case-control study of GlySH-intoxicated patients. Patients were admitted to the emergency departments (EDs) of Chang Gung Memorial Hospital from April 1996 to March 2003 and Taichung Veterans General Hospital from April 2000 to October 2003. Taichung Veterans General Hospital is a medical center serving the middle area of Taiwan. A poison control center is located inside the hospital. Chang Gung Memorial Hospital is a medical center and referral center serving the north area of

Results

Fifty-eight patients (19 men and 39 women, P = .38) were enrolled in our study. As shown in Table 1, Table 2, the patients' age was 48.8 ± 15.8 years. Forty-one patients survived GlySH intoxication and 17 died. The most common intoxication reason was attempted suicide (50/58, 86.2%). The most common symptoms were nausea/vomiting (28/58, 48.3%), oral pain (17/58, 29.3%), and abdominal pain (10/58, 17.2%). Fifteen patients (15/58, 25.9%) drank ethanol alcohol at the same time as well. The

Discussion

The main purpose of this study was to test the association between abnormal CXR and GlySH poisoning survivorship. According to Breslow and Day [10], the odds ratio of death between abnormal and normal CXR is P1(1 − P2)/P2(1 − P1) = 0.824(1 − 0.244)/0.244(1 − 0.824) = 14.5, where P1 refers to the proportion of abnormal CXR in the deceased group and P2 refers to the proportion of abnormal CXR in the survival group. Therefore, the sample size (n) of 58 (17 deceased and 41 survivors) reached

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