title: Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation.
abstract: Zinc phosphide (ZnP) containing rodenticide poisoning is a recognized cause of acute liver failure (ALF) in India. When standard conservative measures fail, the sole option is liver transplantation. Records of 41 patients admitted to a single centre with ZnP-induced ALF were reviewed to identify prognostic indicators for requirement of liver transplantation. Patients were analyzed in two groups: group I (n = 22) consisted of patients who either underwent a liver transplant (n = 14) or died without a transplant (n = 8); group II (n = 19) comprised those who survived without liver transplantation. International normalized ratio (INR) in group I was 9 compared to 3 in group II (p < 0.001). Encephalopathy occurred only in group I. Model for End-Stage Liver Disease (MELD) score in group I was 41 compared to 24 in group II (p < 0.001). MELD score of 36 (sensitivity of 86.7 %, specificity of 90 %) or a combination of INR of 6 and encephalopathy (sensitivity of 100 %, specificity of 83 %) were the best indicators of mortality. Such patients should undergo urgent liver transplantation.
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: Vivek
authors: V
authors: Saraf
authors: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors: Supriya
authors: S
authors: Pande
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: Unnikrishnan
authors: U
authors: Gopalakrishnan
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: Dinesh
authors: D
authors: Balakrishnan
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: Ramachandran N
authors: RN
authors: Menon
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: O V
authors: OV
authors: Sudheer
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India.
authors: Puneet
authors: P
authors: Dhar
authors: Department of Gastro Surgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Kochi, 682 041, India. sudhisalini@vsnl.net.
authors: S
authors: S
authors: Sudhindran
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged; D015999:Multivariate Analysis; D010720:Phosphines / Q000506:poisoning*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012378:Rodenticides / Q000506:poisoning*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult; D017967:Zinc Compounds / Q000506:poisoning*
chemical_list: D015415:Biomarkers; D010720:Phosphines; D012378:Rodenticides; D017967:Zinc Compounds; C009701:zinc phosphide
keywords: Acute liver failure; King’s College criteria; Zinc phosphide