Predictors of acute kidney injury after paraquat intoxication
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Cheng-Hao Weng1,*, Hui-Hsiang Chen1,*, Ching-Chih Hu2, Wen-Hung Huang1, Ching-Wei Hsu1, Jen-Fen Fu3, Wey-Ran Lin4, I-Kwan Wang5 and Tzung-Hai Yen1,6,7
1Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
2Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
3Department of Medical Research, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
4Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
5Department of Nephrology, Chang Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
6Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
7Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
*These authors contributed equally to this work
Tzung-Hai Yen, email: firstname.lastname@example.org
Keywords: paraquat, suicide, acute kidney injury, SOFA, AKIN
Received: March 14, 2017 Accepted: May 07, 2017 Published: May 18, 2017
Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO2 (P = 0.006) and higher alveolar-arterial O2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO2 at admission (P = 0.031), higher PaO2 at admission (P = 0.015), lower nadir PaCO2 (P = 0.001) and lower nadir HCO3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.
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