期刊
WORLD JOURNAL OF GASTROENTEROLOGY
卷 23, 期 7, 页码 1262-1267出版社
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v23.i7.1262
关键词
Mushroom; Liver; Outcome; Intoxication; Bilirubin
AIM To identify early predictive markers of poor outcomes in patients with acute liver injury from wild mushroom intoxication. METHODS This observational, retrospective record review involved adults aged >= 18 years admitted to emergency department with mushroom intoxication from January 2005 to December 2015. The diagnosis of mushroom intoxication was based on the following: (1) a positive history of recent wild mushroom intake (either raw or cooked); (2) the onset of gastrointestinal symptoms, such as watery diarrhea, vomiting, and/or abdominal pain, after ingestion; and (3) the exclusion of other possible causes of acute liver injury. Acute liver injury was defined by a > 5-fold elevation of liver enzymes or moderate coagulopathy [international normalized ratio (INR) > 2.0]. Clinical and laboratory findings were compared in survivors and non-survivors. RESULTS Of 93 patients with mushroom intoxication, 23, 11 men (47.8%) and 12 women (52.2%), of median age 61 years, developed acute liver injury. The overall inhospital mortality rate was 43.5% (10/23). Among the laboratory variables, mean serum alkaline phosphatase (73.38 +/- 10.89 mg/dL vs 180.40 +/- 65.39 mg/dL, P < 0.01), total bilirubin (2.312 +/- 1.16 mg/dL vs 7.16 +/- 2.94 mg/dL, P < 0.01) concentrations and indirect/direct bilirubin (2.45 +/- 1.39 mg/dL vs 0.99 +/- 0.45 mg/dL, P < 0.01) ratio as well as prothrombin time (1.88 +/- 0.83 mg/dL vs 10.43 +/- 4.81 mg/dL, P < 0.01), and activated partial thromboplastin time (aPTT; 32.48 +/- 7.64 s vs 72.58 +/- 41.29 s, P = 0.01), were significantly higher in non-survivors than in survivors. Logistic regression analysis showed that total bilirubin concentration (OR = 3.58, 95% CI: 1.25-10.22), indirect/direct bilirubin ratio (OR = 0.14, 95% CI: 0.02-0.94) and aPTT (OR = 1.30, 95% CI: 1.04-1.63) were significantly associated with mortality. All patients with total bilirubin > 5 mg/dL or aPTT > 50 s on day 3 died. CONCLUSION Monitoring of bilirubin concentrations and aPTT may help in predicting clinical outcomes in patients with acute liver injury from wild mushroom intoxication.
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