title: Predictors of acute respiratory distress syndrome in patients with paraquat intoxication.
abstract: BACKGROUND
  Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters.
  
  
  METHODS
  In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed.
  
  
  RESULTS
  The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN48-h scores (P<0.009), SOFA48-h scores (P<0.001), and time to ARDS/nadir PaO2 (P=0.008) but also suffered from lower nadir PaO2 (P<0.001), nadir AaDO2 (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA48-h scores <3 and SOFA48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS.
  
  
  CONCLUSIONS
  The analytical results indicate that SOFA48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Chang Gung University, College of Medicine, Taoyuan, Taiwan ; Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Hu
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
mesh_terms: D000328:Adult; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D006540:Herbicides; D010269:Paraquat