Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4799-4809
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4799
Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning
Yue Song, Hua Wang, Yu-Hong Tao
Yue Song, Hua Wang, Yu-Hong Tao, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yue Song, Hua Wang, Yu-Hong Tao, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Song Y and Wang H designed the study, made the review, and wrote the manuscript; Song Y, Wang H, and Tao YH made the literature search, made table, and reviewed the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of the West China Second University Hospital, Sichuan University. Approval No: 2020(004).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Hong Tao, PhD, Chief Doctor, Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20 Renmin Road, Chengdu 610041, Sichuan Province, China. hxtyh@sina.com
Received: November 6, 2021
Peer-review started: November 6, 2021
First decision: December 27, 2021
Revised: December 31, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 26, 2022
Processing time: 199 Days and 3.8 Hours
Abstract
BACKGROUND

There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication (APP).

AIM

To optimize a predictive scoring system for mortality in children with APP.

METHODS

A total of 113 children with APP from January 1, 2010 to January 1, 2020 were enrolled in this study. These patients were divided into survivors and non-survivors. We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors. The survival rates of patients with different values of the pediatric critical illness score (PCIS) were assessed using kaplan-meier survival analysis. The best scoring system was established by using the area under the receiver operating characteristic curve analysis.

RESULTS

The overall mortality rate was 23.4%. All non-survivors died within 20 days; 48.1% (13/27) died within 3 days, and 70.3% (19/27) died within 7 days. Compared to survivors, the non-survivors were older, had higher white blood cell count, alanine aminotransferase (ALT), aspartate aminotransferase, serum creatinine, blood urea nitrogen, glucose, and pediatric early warning score, and had lower platelet count, albumin, Serum sodium (Na+) and PCIS. ALT and PCIS were the independent prognostic risk factors for children with APP. The survival rate of children classified as extremely critical patients (100%) was lower than that of children classified as critical (60%) or noncritical (6.7%) patients. The specificity of ALT was high (96.51%), but the sensitivity was low (59.26%). The sensitivity and specificity of ALT combined with PCIS were high, 92.59% and 87.21%, respectively. The difference in mortality was significantly higher for ALT combined with PCIS (area under the receiver operating characteristic: 0.937; 95%CI: 0.875-0.974; P < 0.05).

CONCLUSION

In our study, ALT and PCIS were independent prognostic risk factors for children with APP. ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Keywords: Acute paraquat poisoning; Children; Pediatric critical illness score; Alanine aminotransferase; Prognosis

Core Tip: The mortality rate of children with acute paraquat intoxication (APP) was high. Early and accurate prediction of mortality is very important for children with APP in clinical decision-making. However, there is no scoring system that can be used to predict the mortality of children with APP. In our study, we discovered that alanine aminotransferase (ALT) and the pediatric critical illness score (PCIS) were independent prognostic risk factors for children with APP. ALT combined with the PCIS is an optimal predictive mortality scoring system for children with APP.