Öz
Background/Aim: Mushroom poisoning (MP) can result in a wide range of clinical presentations from mild gastrointestinal complaints to hepatic necrosis or acute liver failure (ALF) requiring liver transplantation (LT). Although several predictive parameters were studied, a guideline based on a consensus is still lacking. This study aimed to investigate the parameters associated with LT-free survival in patients admitted to the emergency department with MP.
Methods: This retrospective cohort study was conducted on 420 adult patients admitted to the emergency department with symptoms of MP after ingestion of mushrooms. Patients with viral hepatitis, autoimmune liver disease, acetaminophen or salicylate toxicity, or other chronic liver diseases were excluded. Favorable outcome was defined as LT-free survival while adverse outcome was defined as death or LT. Liver transaminase levels, treatment modalities, and outcomes were analyzed.
Results: The median age of the patients was 46.9 (31-60) years and 59.8% were female. The season with the most MP admissions was autumn (57.6%). The latent periods of 337 (80.3%) patients were between 0-6 hours, and of 83 (19.8%), longer than 6 hours. Among them, 227 (54.0%) patients were treated with gastric lavage, 272 (64.8%), with activated charcoal, 27 (6.4%) with conventional therapy (CT) and 2 (0.5%) with hemodialysis. All 420 patients received supportive therapy (ST). Patients who received CT had higher mean AST and ALT levels than patients who received only decontamination or ST (P<0.001). One hundred and sixty-two (38.6%) patients refused further treatment while under observation. Among patients who received CT+ST, patients with adverse outcomes (liver transplant or death) had higher transaminase levels (AST: P=0.009, and ALT: P=0.008) and higher coagulation parameters (PTT: P=0.016, INR: P=0.009).
Conclusion: The duration of the latent period, AST, ALT, PTT, and INR may be used as predictors of poor outcome.
Anahtar Kelimeler
Mushroom poisoning Emergency department Amanita Phalloides Prognosis
Kaynakça
- 1. Bonacini M, Shetler K, Yu I, et al. Features of Patients With Severe Hepatitis Due to Mushroom Poisoning and Factors Associated With Outcome. Clinical Gastroenterology and Hepatology. 2017;15:776–9. doi: 10.1016/j.cgh.2016.11.039
- 2. Wennig R, Eyer F, Schaper A, et al. Mushroom Poisoning. Deutsches Arzteblatt International. 2020;117:701–8. doi: 10.3238/arztebl.2020.0701
- 3. Jaeger A, Jehl F, Flesch F, et al. Kinetics of amatoxins in human poisoning: therapeutic implications. Journal of toxicology Clinical toxicology. 1993;31:63–80. doi: 10.3109/15563659309000374
- 4. Trabulus S, Altiparmak MR. Clinical features and outcome of patients with amatoxin-containing mushroom poisoning. Clinical Toxicology. 2011;49:303–10. doi: 10.3109/15563650.2011.565772
- 5. Escudié L, Francoz C, Vinel JP, et al. Amanita phalloides poisoning: Reassessment of prognostic factors and indications for emergency liver transplantation. Journal of Hepatology. 2007;46:466–73. doi: 10.1016/j.jhep.2006.10.013
- 6. Kim T, Lee D, Lee JH, et al. Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury. World Journal of Gastroenterology. 2017;23:1262–7. doi: 10.3748/wjg.v23.i7.1262
- 7. Ye Y, Liu Z. Management of Amanita phalloides poisoning: A literature review and update. Journal of Critical Care. 2018;46:17–22. doi: 10.1016/j.jcrc.2018.03.028
- 8. Diaz JH. Amatoxin-Containing Mushroom Poisonings: Species, Toxidromes, Treatments, and Outcomes. Wilderness and Environmental Medicine 2018;29:111–8. doi: 10.1016/j.wem.2017.10.002
- 9. Enjalbert F, Rapior S, Nouguier-Soulé J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. Journal of toxicology Clinical toxicology. 2002;40:715–57. doi: 10.1081/clt-120014646
- 10. Yildiz BD, Abbasoglu O, Saglam A, et al. Urgent liver transplantation for Amanita phalloides poisoning. Pediatric Transplantation. 2008;12:105–8. doi: 10.1111/j.1399-3046.2007.00838.x
- 11. Ferreira R, Romãozinho JM, Amaro P, et al. Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides. European Journal of Gastroenterology and Hepatology. 2011;23:1226–32. doi: 10.1097/MEG.0b013e32834c7b8f
- 12. Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. Journal of Hepatology. 2005;42:202–9. doi: 10.1016/j.jhep.2004.10.023
- 13. Ye Y, Liu Z, Zhao M. CLIF-OF >9 predicts poor outcome in patients with Amanita phalloides poisoning. American Journal of Emergency Medicine. 2021;39:96–101. doi: 10.1016/j.ajem.2020.01.027
- 14. Yardan T, Baydin A, Eden AO, et al. Wild mushroom poisonings in the Middle Black Sea region in Turkey: Analyses of 6 years. Human and Experimental Toxicology. 2010;29:767–71. doi: 10.1177/0960327110361758
- 15. Keller SA, Klukowska-Rötzler J, Schenk-Jaeger KM, et al. Mushroom poisoning—a 17 year retrospective study at a level I university emergency department in Switzerland. International Journal of Environmental Research and Public Health. 2018;15. doi: 10.3390/ijerph15122855
- 16. Colak S, Kandis H, Afacan MA, et al. Assessment of patients who presented to the emergency department with mushroom poisoning. Human and Experimental Toxicology 2015;34:725–31. doi: 10.1177/0960327114557902
- 17. Ahishali E, Boynuegri B, Ozpolat E, et al. Approach to mushroom intoxication and treatment: Can we decrease mortality? Clinics and Research in Hepatology and Gastroenterology 2012;36:139–45. doi: 10.1016/j.clinre.2011.11.004
- 18. White J, Weinstein SA, de Haro L, et al. Mushroom poisoning: A proposed new clinical classification. Toxicon. 2019;157:53–65. doi: 10.1016/j.toxicon.2018.11.007
- 19. Persson HE, Sjoberg GK, Haines JA, et al. Poisoning Severity Score. Clinical Toxicology. 1998;6:205–13.
- 20. Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the united states. Mycologia. 2018;110:637–41. doi: 10.1080/00275514.2018.1479561.
Öz
Kaynakça
- 1. Bonacini M, Shetler K, Yu I, et al. Features of Patients With Severe Hepatitis Due to Mushroom Poisoning and Factors Associated With Outcome. Clinical Gastroenterology and Hepatology. 2017;15:776–9. doi: 10.1016/j.cgh.2016.11.039
- 2. Wennig R, Eyer F, Schaper A, et al. Mushroom Poisoning. Deutsches Arzteblatt International. 2020;117:701–8. doi: 10.3238/arztebl.2020.0701
- 3. Jaeger A, Jehl F, Flesch F, et al. Kinetics of amatoxins in human poisoning: therapeutic implications. Journal of toxicology Clinical toxicology. 1993;31:63–80. doi: 10.3109/15563659309000374
- 4. Trabulus S, Altiparmak MR. Clinical features and outcome of patients with amatoxin-containing mushroom poisoning. Clinical Toxicology. 2011;49:303–10. doi: 10.3109/15563650.2011.565772
- 5. Escudié L, Francoz C, Vinel JP, et al. Amanita phalloides poisoning: Reassessment of prognostic factors and indications for emergency liver transplantation. Journal of Hepatology. 2007;46:466–73. doi: 10.1016/j.jhep.2006.10.013
- 6. Kim T, Lee D, Lee JH, et al. Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury. World Journal of Gastroenterology. 2017;23:1262–7. doi: 10.3748/wjg.v23.i7.1262
- 7. Ye Y, Liu Z. Management of Amanita phalloides poisoning: A literature review and update. Journal of Critical Care. 2018;46:17–22. doi: 10.1016/j.jcrc.2018.03.028
- 8. Diaz JH. Amatoxin-Containing Mushroom Poisonings: Species, Toxidromes, Treatments, and Outcomes. Wilderness and Environmental Medicine 2018;29:111–8. doi: 10.1016/j.wem.2017.10.002
- 9. Enjalbert F, Rapior S, Nouguier-Soulé J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. Journal of toxicology Clinical toxicology. 2002;40:715–57. doi: 10.1081/clt-120014646
- 10. Yildiz BD, Abbasoglu O, Saglam A, et al. Urgent liver transplantation for Amanita phalloides poisoning. Pediatric Transplantation. 2008;12:105–8. doi: 10.1111/j.1399-3046.2007.00838.x
- 11. Ferreira R, Romãozinho JM, Amaro P, et al. Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides. European Journal of Gastroenterology and Hepatology. 2011;23:1226–32. doi: 10.1097/MEG.0b013e32834c7b8f
- 12. Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. Journal of Hepatology. 2005;42:202–9. doi: 10.1016/j.jhep.2004.10.023
- 13. Ye Y, Liu Z, Zhao M. CLIF-OF >9 predicts poor outcome in patients with Amanita phalloides poisoning. American Journal of Emergency Medicine. 2021;39:96–101. doi: 10.1016/j.ajem.2020.01.027
- 14. Yardan T, Baydin A, Eden AO, et al. Wild mushroom poisonings in the Middle Black Sea region in Turkey: Analyses of 6 years. Human and Experimental Toxicology. 2010;29:767–71. doi: 10.1177/0960327110361758
- 15. Keller SA, Klukowska-Rötzler J, Schenk-Jaeger KM, et al. Mushroom poisoning—a 17 year retrospective study at a level I university emergency department in Switzerland. International Journal of Environmental Research and Public Health. 2018;15. doi: 10.3390/ijerph15122855
- 16. Colak S, Kandis H, Afacan MA, et al. Assessment of patients who presented to the emergency department with mushroom poisoning. Human and Experimental Toxicology 2015;34:725–31. doi: 10.1177/0960327114557902
- 17. Ahishali E, Boynuegri B, Ozpolat E, et al. Approach to mushroom intoxication and treatment: Can we decrease mortality? Clinics and Research in Hepatology and Gastroenterology 2012;36:139–45. doi: 10.1016/j.clinre.2011.11.004
- 18. White J, Weinstein SA, de Haro L, et al. Mushroom poisoning: A proposed new clinical classification. Toxicon. 2019;157:53–65. doi: 10.1016/j.toxicon.2018.11.007
- 19. Persson HE, Sjoberg GK, Haines JA, et al. Poisoning Severity Score. Clinical Toxicology. 1998;6:205–13.
- 20. Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the united states. Mycologia. 2018;110:637–41. doi: 10.1080/00275514.2018.1479561.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ekim 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 5 Sayı: 10 |
