title: The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning.
abstract: BACKGROUND
  Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning.
  
  
  METHODS
  Lung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis.
  
  
  RESULTS
  Of 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and "no obvious lesion". With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001).
  
  
  CONCLUSIONS
  The volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Xin
authors.initials: X
authors.lastname: Kang
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Da-Yong
authors.initials: DY
authors.lastname: Hu
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Chang-Bin
authors.initials: CB
authors.lastname: Li
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Li
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Fan
authors.affiliation: Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Tang
authors.affiliation: Department of Medical Statistics, College of Medicine, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Zi-Sheng
authors.initials: ZS
authors.lastname: Ai
authors.affiliation: Department of Biomedical Engineering and Pharmacy, University of Houston, TX, United States of America.
authors.forename: Tianfu
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Biomedical Engineering and Pharmacy, University of Houston, TX, United States of America.
authors.forename: Chandra
authors.initials: C
authors.lastname: Mohan
authors.affiliation: Renal Path Diagnostics, Pathologists BioMedical Laboratories & Department of Pathology, Baylor University Medical Center, Dallas, TX, United States of America.
authors.forename: Xin J
authors.initials: XJ
authors.lastname: Zhou
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Jun-Yan
authors.initials: JY
authors.lastname: Liu
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
authors.forename: Ai
authors.initials: A
authors.lastname: Peng
mesh_terms: D055371:Acute Lung Injury / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000401:mortality; D000328:Adult; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D006540:Herbicides; D010269:Paraquat
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