Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores

Abstract

The aim of this study was to evaluate the scores of the Acute Physiology and Chronic Health Evaluation (APACHE) II and a modified APACHE II system (MAS), without parameters of biochemical tests; and to find prognostic value of individual elements of the APACHE II and MAS in predicting outcomes in organophosphate (OP) poisoning. Data were collected from 131 patients. The median (25th—75th percentiles) of APACHE II score for survivors without intubation were found to be lower than those of non survivors or survivors with intubation and ventilation, [4 (1—7); versus 17.5 (7.8—29), and 13.5 (7.8—16.3)]. Logistic regression analysis identified white blood cell (WBC), potassium, Glasgow coma scale (GCS), age and sodium in APACHE II; GCS and mean arterial pressure in MAS system as prognostically valuable. There was no statistically significance difference between APACHE II and MAS scores in terms of area under Receiver Operating Characteristic Curve [(0.902, 95% confidence interval: (0.837—0.947) for APACHE II), and (0.892, 95% confidence interval: (0.826—0.940) for MAS); P = 0.74) to predict need for intubation. It is concluded usage of MAS facilitates the prognostication of the OP poisoned patients due to simplicity, less time-consuming and effectiveness in an emergency situation. Human & Experimental Toxicology (2007) 26: 573—578.

Keywords

Acute Physiology and Chronic Health Evaluation II organophosphate poisoning outcomes

References

Bardin PG et al. Organophosphate and carbamate poisoning. Archives of Internal Medicine 1994; 154: 1433—41.

Clark RF Insecticides: organic phosphorous compounds and carbamates. In Goldfrank LR et al eds. Goldfrank's toxicologic emergencies. McGraw Hill, 2002: 1346—60.

Hodgson M. , Parkinson D. Diagnosis of organophosphate intoxication [letter]. The New England Journal of Medicine 1985; 313: 329.

Teasdale G. , Jennet B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974; 11: 81—84.

Levy DE et al. Prognosis in non-traumatic coma. Annals of Internal Medicine 1981; 94: 293—301.

Jensen M. , Neunzig HP , Emskotter T.

Outcome prediction in comatose patients: significance of reflex eye movement analysis. Journal of

Neurology, Neurosurgery and Psychiatry 1987; 50: 389—92.

Bailey B. , Amre DK , Gaudreault P. Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Critical Care Medicine 2003 ; 31: 299—305.

Lee P. , Tai DY Clinical features of patients with acute organophosphate poisoning requiring intensive care. Intensive Care Medicine 2001 ; 27: 694—99.

Sunqurtekin H. , Balci C. Organophosphate poisoning in the intensive care unit. Critical Care 2003; 7(Suppl 2): 244—49.

10.

Bilgin TE et al. The comparison of the efficacy of scoring systems in organophosphate poisoning. Toxicology and Industrial Health 2005; 21: 141—46.

11.

Sungurtekin H. , Curses E. , Balci C. Evaluation of several clinical scoring tools in organophosphate poisoned patients. Clinical Toxicology 2006; 44: 121—26.

12.

Eizadi-Mood N. , Gheshlaghi F. , Sharafi E.

Fatal poisoning cases admitted to the poisoning emergency department of Noor Hospital, Isfahan, Iran. Iranian Journal of Forensic

Medicine 2003; 31: 122—27.

13.

Carlton FB , Simpson WM , Haddad LM The organophosphate and other insecticides. In Haddad LM , Shannon MW , Winchester JF eds. Clinical management of poisoning and drug overdose. WB, Saunders Company, 1998: 836—45.

14.

Knaus WA et al. APACHE — acute physiology and chronic health evaluation: a physiologically based classification system. Critical Care Medicine 1981; 9: 591—97.

15.

Knaus WA et al. APACHE II: a severity of disease classification system. Critical Care Medicine 1985; 13: 818—29.

16.

Hanley JA , McNeil BJ The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29—36.

17.

Hosmer DW , Lemeshow S. Assessing the fit of the model. In Applied logistic regression . John Wiley & Sons, 2000: 160—64.

18.

Youden WJ Index for rating diagnostic tests. Cancer 1950; 3: 32—35.

19.

Brum G. , Teixeira E. , Barroso C. Severity evaluation of ventilated patients at a respiratory intensive care unit with APACHE II system. Acta Medica Portuguesa 1992; 5: 75—78.

20.

Durham WF , Hayes WJ Organic phosphorus poisoning and its therapy. With special reference to modes of action and compounds that reactivate inhibited cholinesterase . Archives of Environmental Health 1962 ; 5: 21—33.

21.

De Silva HJ , Wijewickrema R. , Senanayake N. Does pralidoxime affect outcome in acute organophosphorus poisoning? Lancet 1992; 339: 1136—38.