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  • Title: Pneumomediastinum predicts early mortality in acute paraquat poisoning.
    Author: Zhou CY, Kang X, Li CB, Li XH, Liu Y, Wang Z, Wang L, Wu T, Mohan C, Hu DY, Peng A.
    Journal: Clin Toxicol (Phila); 2015 Jul; 53(6):551-6. PubMed ID: 26072933.
    Abstract:
    CONTEXT: In paraquat (PQ) poisoning, death often occurs after the appearance of pneumomediastinum (PM). However, the clinical features and eventual outcome of PM in PQ intoxication remains unclear. OBJECTIVE: We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. MATERIALS AND METHODS: Enrolled PQ-poisoned patients (n = 75) were divided into two groups according to whether PM could be detected by chest computed tomography or not. The study outcomes included 5- and 90-day death after intoxication. Survival curves were derived using the Kaplan-Meier method, and mortality risk factors were analyzed by forward stepwise Cox regression analysis. RESULTS: PM was documented in 21.3% of the patients (16/75); in 13 of them PM set in within 3 days of PQ ingestion. 15 patients died within 3 days of appearance of PM. Compared with patients without PM, those with PM were younger (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). DISCUSSION AND CONCLUSION: Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.
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