J Korean Soc Emerg Med.  2020 Oct;31(5):475-482.

Performance of the PSS, APACHE II, and SOFA score as in-hospital prognostic tool in glufosinate-poisoned patients in the intensive care unit

• Ahn S
• Kim Y
• Lee J

Abstract

Objective
Glufosinate-containing herbicide is being used increasingly in agriculture. Its poisoning is a worldwide concern. This study assessed the ability of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring systems, and Sequential Organ Failure Assessment (SOFA) score to predict mortality in intensive care unit patients poisoned with glufosinate.
Methods
This was a retrospective cohort study conducted from January 2001 to January 2019. The demographic factors, hemodynamic variables, and laboratory variables were compared in survivors and non-survivors. Using multivariate logistic analysis, the data for the total population were analyzed retrospectively to determine the factors associated with mortality. Significant predictive variables, PSS, APACHE II scoring system, and SOFA score were compared by analyzing the receiver operating characteristic curves.
Results
Two hundred seventy-six patients (mean age, 56 years) were enrolled in this study. Of the 276 patients, 240 (87.0%) survived, and 36 (13.0%) died. The factors associated with mortality were a decreased mean arterial blood pressure, Glasgow Coma Scale, partial pressure of arterial oxygen/fraction of inspired oxygen, HCO₃-, pH, and HCO₃-, and an increased lactate, ammonia, C-reactive protein, PSS, SOFA score, and APACHE II score. Dyspnea, use of vasopressors, and application of mechanical ventilation were associated with mortality. In multivariate analysis, Glasgow Coma Scale<9, HCO₃- <15.8 mmol/L, lactate>5.2 mmol/L, use of vasopressors, and application of mechanical ventilation were predictive of mortality. The areas under the curve and 95% confidence intervals for these indicators were 0.920 (0.834-0.981), 0.865 (0.792-0.923), and 0.824 (0.752-0.897) for the PSS, APACHE II, and SOFA, respectively.
Conclusion
The PSS can be used to predict in-hospital mortality and stratify the risk among glufosinate-poisoned patients.

Keyword

Glufosinate; Poisoning; Mortality