Construction of a Crucial Score to Predict the Outcome of Patients with Aluminum Phosphide Poisoning at the Poison Control Center, Ain Shams University Hospitals (PCC-ASUH)

• Published in: QJM : An International Journal of Medicine Vol. 117; no. Supplement_2
• Main Authors: Zaki El seaidy, Fatma Fawzy, Abou Anza, Rasha El Hussaini, Mohamed, Rania Hussien
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2024
• Subjects: Poisoning; Aluminum phosphide (ALP); Predictive factors; Scoring systems; Mortality
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcae175.255

Introduction Acute aluminum phosphide (ALP) poisoning has become a major toxicological challenge in developing countries due to increasing mortality rate and absence of specific antidote. The aim of this study was to “Evaluate the value of APACHE II and SOFA scores in the prediction of outcome in patients with acute ALP poisoning and construct a predictive model for ALP poisoning”. Subjects and Methods A prospective cross sectional study of acute ALP poisoned patients admitted to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during the period from August 2022 to April 2023. Patients’ data were collected in a patient sheet and included sociodemographic data, clinical and laboratory data of APACHE II and SOFA scores, ECG evaluation and the outcome. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression analysis have been applied for data analysis. Results A total of 110 ALP poisoned patients were evaluated with 52 survivors and 58 non-survivors. Evaluating the predictive value of APACHE II and SOFA scores, the cut off point of APACHE II score was > 6 and AUC was 0.969 achieved 98.28% sensitivity and 86.54% specificity. The cut off point of SOFA score was > 2 and AUC was 0.983 achieved 100% sensitivity and 86.54% specificity. Univariate and multivariate regression analysis revealed that six factors were the most significant predictive factors of mortality: PO2, PH value, Glasgow coma scale (GCS), Mean arterial pressure (MAP), HCO3 level and abnormal ECG. They were valid to construct the predictive new score at cut off value of PO2 < 90% mmHg, PH < = 7.28, GCS < =12, MAP <70 mmHg, HCO3 < = 12.6 mEq/L. Scoring system was constructed of these six parameters each take a constant logistic score to give a total score of 33. The power of the predictive new score to discriminate between survivors and non-survivors at cut off > 19 was excellent (AUC: 0.999) that achieved 96.55% sensitivity and 100% specificity. Conclusion High sensitivity and specificity values with excellent AUC reflect the usefulness of the new predictive score and recommended its use at emergency room as it is simple, quick, easy to use and appliciable even in small hospitals to predict the outcome of acute ALP poisoned patients.