title: Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury.
abstract: OBJECTIVE
  To identify early predictive markers of poor outcomes in patients with acute liver injury from wild mushroom intoxication.
  
  
  METHODS
  This observational, retrospective record review involved adults aged ≥ 18 years admitted to emergency department with mushroom intoxication from January 2005 to December 2015. The diagnosis of mushroom intoxication was based on the following: (1) a positive history of recent wild mushroom intake (either raw or cooked); (2) the onset of gastrointestinal symptoms, such as watery diarrhea, vomiting, and/or abdominal pain, after ingestion; and (3) the exclusion of other possible causes of acute liver injury. Acute liver injury was defined by a > 5-fold elevation of liver enzymes or moderate coagulopathy [international normalized ratio (INR) > 2.0]. Clinical and laboratory findings were compared in survivors and non-survivors.
  
  
  RESULTS
  Of 93 patients with mushroom intoxication, 23, 11 men (47.8%) and 12 women (52.2%), of median age 61 years, developed acute liver injury. The overall in-hospital mortality rate was 43.5% (10/23). Among the laboratory variables, mean serum alkaline phosphatase (73.38 ± 10.89 mg/dLvs180.40 ± 65.39 mg/dL,P< 0.01), total bilirubin (2.312 ± 1.16 mg/dLvs7.16 ± 2.94 mg/dL,P< 0.01) concentrations and indirect/direct bilirubin (2.45 ± 1.39 mg/dLvs0.99 ± 0.45 mg/dL,P< 0.01) ratio as well as prothrombin time (1.88 ± 0.83 mg/dLvs10.43 ± 4.81 mg/dL,P< 0.01), and activated partial thromboplastin time (aPTT; 32.48 ± 7.64 svs72.58 ± 41.29 s,P= 0.01), were significantly higher in non-survivors than in survivors. Logistic regression analysis showed that total bilirubin concentration (OR = 3.58, 95%CI: 1.25-10.22), indirect/direct bilirubin ratio (OR = 0.14, 95%CI: 0.02-0.94) and aPTT (OR = 1.30, 95%CI: 1.04-1.63) were significantly associated with mortality. All patients with total bilirubin > 5 mg/dL or aPTT > 50 s on day 3 died.
  
  
  CONCLUSIONS
  Monitoring of bilirubin concentrations and aPTT may help in predicting clinical outcomes in patients with acute liver injury from wild mushroom intoxication.
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Taerim
authors.initials: T
authors.lastname: Kim
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Yoon-Seon
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Bum Jin
authors.initials: BJ
authors.lastname: Oh
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
authors.affiliation: Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000363:Agaricales / Q000737:chemistry*; D000368:Aged; D001663:Bilirubin; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008099:Liver / Q000187:drug effects; D017114:Liver Failure, Acute / Q000139:chemically induced; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000628:therapy*; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Bilirubin; Intoxication; Liver; Mushroom; Outcome