title: Pneumomediastinum predicts early mortality in acute paraquat poisoning.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.
authors.affiliation: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Zhou
authors.forename: Xin
authors.initials: X
authors.lastname: Kang
authors.forename: Chang-Bin
authors.initials: CB
authors.lastname: Li
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.forename: Tianfu
authors.initials: T
authors.lastname: Wu
authors.forename: Chandra
authors.initials: C
authors.lastname: Mohan
authors.forename: Da-Yong
authors.initials: DY
authors.lastname: Hu
authors.forename: Ai
authors.initials: A
authors.lastname: Peng
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008478:Mediastinal Emphysema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D063305:Organ Dysfunction Scores; D010269:Paraquat / Q000506:poisoning*; D011041:Poisoning / Q000000981:diagnostic imaging / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D006540:Herbicides; D010269:Paraquat
keywords: Computed tomography; Mortality; Paraquat; Pneumomediastinum