The Clinical Forecast System Of Paraquat Poisoning Complicated With Early Pulmonary Fibrosis

Pur Pose Pulmonary fibrosis(PF)is the leading cause of death in patients with acute paraquat(PQ)poisoning.The PQ poisoned patients with an early occurrence of PF,the mortality rate is high.Therefore,early detection and intervention of pulmonary fibrosis are the key measures to improving the prognosis of patients with acute PQ poisoning.We plan to use routine hematology and routine examinations as predictive indicators to establish a predictive model of PF in the early stage of PQ,in order to guide PQ acute poisoning treatment decisions and improve prognosis.Methods A retrospective analysis of acute PQ poisoning cases admitted to the emergency intensive care unit of Fuyang Hospital Affiliated to Anhui Medical University from January 2014 to August 2020,basic patient data were collected white blood cell count(WBC),included albumin(ALB),Acid aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),blood glucose(Glu),blood urea nitrogen(BUN),serum creatinine(SCr),serum calcium ion(Ca2+),serum potassium Ion(K+),arterial partial pressure of oxygen(Pa O2),arterial partial pressure of carbon dioxide(Pa CO2),PH value,HCO3-,residual alkali(BE),lactic acid(Lac)and other indicators,immediately and 24 h after admission,calculated the change value of each index according to the limit value and the change in 24 hours.According to the chest high-resolution CT(High Resolution CT,HRCT),we assessed the patient’s PF assessment.Logistic regression model was used to analyze the risk factors of early concurrent pulmonary fibrosis,and then to construct a predictive model.The ROC curve method was used to test the sensitivity and specificity of the indicators,and the Ka PLacn-Meier method was used to analyze the survival curve.Results A total of 120 patients inclued 51 males and 69 females with PQ poisoning who met the research criteria were included in this study.The age were 18-72 years old,with an average of 39.1 years old.69 patients died,and the in-hospital mortality rate was57.5%.67 patients developed early pulmonary fibrosis,the incidence rate was 55.8%.Logtic multiple linear regression model analysis found that:oral swallowed PQ(P=0.033),ΔBUN(P=0.032),ΔK+(P=0.041),ΔPa O2(P=0.021)and ΔLac(P=0.021)are predicted PQ Risk factors for early pulmonary fibrosis in poisoned patients.The risk model is:3.497 PQ swallowed +1.437ΔBUN-2.368ΔK+-1.6ΔPa O2+1.716ΔLAC+2.175.The area under the ROC(Receiver OPerating Characteristic)curve(AUC)is 0.879,and the best cutoff value is 27.198.The blood PQ concentration of patients in the early pulmonary fibrosis group was significantly higher than that in the non-early pulmonary fibrosis group(991±871.0 ug/ml v.s.144±87.0 ug/ml;P <0.001).The score of risk factor prediction model of 120 patients was significantly positively correlated with blood PQ concentration(R = 0.707,P = 0.011).In 120 patients with PQ poisoning,74 patients with early pulmonary fibrosis prediction model risk score >27.198,46 patients with score <27.198,there was a significant difference in overall survival(OS)between the two groups(P = 0.012).The degree of ΔPa O2 decline in patients with severe pulmonary fibrosis was significantly higher than that of moderate(moderate vs severe;-10.16 ± 8.1 vs-19.21 ± 9.3;P = 0.033)and mild patients(mild vs severe;-8.00 ± 5.3vs-19.21 ± 9.3;P = 0.016).Conclusion This study found that: 1.Early pulmonary fibrosis predictors of acute paraquat poisoning include: oral PQ,ΔBUN,ΔK+,ΔPa O2 and ΔLac.2.We established a logistic linear fitting risk model: 3.497 PQ swallowed +1.437ΔBUN-2.368ΔK+-1.6ΔPa O2+1.716ΔLAC+2.175.This model is highly sensitive in predicting the early occurrence of PF in patients with PQ poisoning and can be used to evaluate the prognosis of this type of patients and can be widely promoted in primary hospitals.