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World J Gastroenterol. 2017 Feb 21;23(7):1262-1267. doi: 10.3748/wjg.v23.i7.1262.

Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury.

Author information

1
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.

Abstract

AIM:

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/dL vs 180.40 ± 65.39 mg/dL, P < 0.01), total bilirubin (2.312 ± 1.16 mg/dL vs 7.16 ± 2.94 mg/dL, P < 0.01) concentrations and indirect/direct bilirubin (2.45 ± 1.39 mg/dL vs 0.99 ± 0.45 mg/dL, P < 0.01) ratio as well as prothrombin time (1.88 ± 0.83 mg/dL vs 10.43 ± 4.81 mg/dL, P < 0.01), and activated partial thromboplastin time (aPTT; 32.48 ± 7.64 s vs 72.58 ± 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.

CONCLUSION:

Monitoring of bilirubin concentrations and aPTT may help in predicting clinical outcomes in patients with acute liver injury from wild mushroom intoxication.

KEYWORDS:

Bilirubin; Intoxication; Liver; Mushroom; Outcome

PMID:
28275306
PMCID:
PMC5323451
DOI:
10.3748/wjg.v23.i7.1262
[Indexed for MEDLINE]
Free PMC Article

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