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Delta values as a prognostic marker in methanol poisoning: a retrospective cohort study

Yıl 2023, Cilt: 48 Sayı: 1, 46 - 53, 31.03.2023
https://doi.org/10.17826/cumj.1173429

Öz

Purpose: The aim of the study was to evaluate the mortality prediction performances of delta bicarbonate, delta anion gap, and delta ratio in methanol poisoning (MP) cases.
Materials and Methods: This clinical study, which followed a cross-sectional study design, involved patients with MP who were still alive when they initially arrived at the emergency department of a tertiary care hospital. Patients were divided into two groups mortality and non-mortality. Patients who died during treatment and follow-up were assigned to the mortality group, while others were assigned to the non-mortality group. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off in the diagnostic value measurements of biomarkers predicting mortality.
Results: Nine (20%) of the 45 patients in the study died during their follow-up. The two groups showed a significant difference in the averages of pH, bicarbonate (HCO3-), lactate, anion gap, delta anion gap, delta HCO3-, and delta ratio, but not in the averages of partial carbon dioxide pressure (pCO2). In predicting mortality, pH, anion gap, and delta anion gap were found to have outstanding diagnostic power (AUC>0.9), while HCO3-, delta HCO3-, delta ratio were found to have acceptable diagnostic power (AUC: 0.7-0.8).
Conclusion: Delta anion gap, delta bicarbonate, and delta ratio can be used as prognostic factors in predicting mortality in MP cases.

Destekleyen Kurum

The authors declare no conflict of interest or any financial support.

Proje Numarası

The authors declare no any financial support.

Kaynakça

  • Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: two outbreaks, a single center experience. Alcohol. 2020;88:83-90.
  • Ashurst JV, Nappe TM. Methanol Toxicity. Treasure Island (FL), StatPearls Publishing, 2022.
  • Holt NR, Nickson CP. Severe methanol poisoning with neurological sequelae: implications for diagnosis and management. Intern Med J. 2018;48:335-9.
  • Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department. Emerg Med Pract. 2016;18:1-20.
  • Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3:208-25.
  • Zakharov S, Kurcova I, Navratil T, Salek T, Komarc M, Pelclova D. Is the measurement of serum formate concentration useful in the diagnostics of acute methanol poisoning? a prospective study of 38 patients. Basic Clin Pharmacol Toxicol. 2015;116:445-51.
  • Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med. 2004;30:1842-6.
  • Kraut JA, Madiast NE. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol. 2007;2:162-74.
  • Gallagher N, Edwards FJ. The diagnosis and management of toxic alcohol poisoning in the emergency department: a review article. Adv J Emerg Med. 2019;3:e28.
  • Kraut JA, Mullins ME. Toxic alcohols. N Engl J Med. 2018;378:270-80.
  • Kraut JA. Diagnosis of toxic alcohols: limitations of present methods. Clin Toxicol (Phila). 2015;53:589-95.
  • Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40:415-46.
  • Farwell WR, Taylor EN. Serum anion gap, bicarbonate and biomarkers of inflammation in healthy individuals in a national survey. CMAJ. 2010;182:137-41.
  • Feldman M, Soni N, Dickson B. Influence of hypoalbuminemia or hyperalbuminemia on the serum anion gap. J Lab Clin Med. 2005;146:317-20.
  • Rudkin SE, Grogan TR, Treger RM. The Δ anion gap/Δ bicarbonate ratio in early lactic acidosis: time for another delta? Kidney360. 2021;2:20.
  • Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15:625-32.
  • Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae – a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol. 2009;9:5.
  • Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia S. Prognostic factors in methanol poisoning. Hum Exp Toxicol. 2007;26:583-6.
  • Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P et al. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol (Phila). 2014;52:1013-24..
  • Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila). 2007;45:152-7.
  • Aghababaeian H, Ahvazi LA, Ostadtaghizadeh A. The methanol poisoning outbreaks in Iran 2018. Alcohol Alcohol. 2019;54:128-30.
  • WHO. Global Status Report on Alcohol and Health 2018. Geneva, World Health Organization, 2008.
  • Reddy P, Mooradian AD. Clinical utility of anion gap in deciphering acid–base disorders. Int J Clin Pract. 2009;63:1516-25.
  • Lipnick MS, Braun AB, Cheung JTW, Gibbons FK, Christopher KB. The difference between critical care initiation anion gap and prehospital admission anion gap is predictive of mortality in critical illness. Crit Care Med. 2013;41:49-59.
  • Xie K, Zheng C, Wang GM, Daio YF, Luo C, Wang E, et al. Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study. BMC Surg. 2022;22:186.
  • Zakharov S, Navrátil T, Pelclova D. Analysis of serum anion gap and osmolal gap in diagnosis and prognosis of acute methanol poisoning: clinical study in 86 patients. Monatshefte fur Chemie. 2015;146:787-94.
  • Arslan B, Akdağ D, Ünlü N, Arslan A, Açık V. The prognostic value of red cell distribution width for in-hospital mortality in patients with methanol poisoning. Hum Exp Toxicol. 2021;40:196-202.
  • Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes – a multicenter study. Clin Toxicol (Phila). 2012;50:823-31.
  • Persson HE, Sjöberg GK, Haines JA, De Garbino JP. Poisoning Severity Score: grading of acute poisoning. J Toxicol Clin Toxicol. 2009;36:205-13.
  • Casey PB, Dexter EM, Michell J, Vale JA. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol. 1998;36:215-7.
  • Zakharov S, Navratil T, Salek T, Kurcova I, Pelclova D. Fluctuations in serum ethanol concentration in the treatment of acute methanol poisoning: a prospective study of 21 patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159:666-76.

Metanol zehirlenmesinde prognoz belirteci olarak delta değerleri: retrospektif kohort çalışması

Yıl 2023, Cilt: 48 Sayı: 1, 46 - 53, 31.03.2023
https://doi.org/10.17826/cumj.1173429

Öz

Amaç: Çalışmanın amacı metanol zehirlenmesi (MZ) vakalarında delta bikarbonat, delta anyon açığı ve delta oranının mortalite tahmin performanslarını değerlendirmektir.
Gereç ve Yöntem: Kesitsel bir çalışma tasarımına göre yapılan bu klinik çalışma, üçüncü basamak bir hastanenin acil servisine ilk geldiklerinde hala hayatta olan MZ'li hastaları içeriyordu. Hastalar ölenler ve sağ kalanlar olarak iki gruba ayrıldı. Tedavi ve takip sırasında ölen hastalar mortalite grubuna, diğerleri non-mortalite grubuna alındı. Mortaliteyi öngören biyobelirteçlerin tanısal değer ölçümlerinde eşik değeri belirlemek için Alıcı İşlem Karakteristiği (ROC) analizi kullanıldı.
Bulgular: Çalışmadaki 45 hastanın dokuzu (%20) takipleri sırasında öldü. İki grup, pH, bikarbonat (HCO3-), laktat, anyon açığı, delta anyon açığı, delta HCO3- ve delta oranı ortalamalarında önemli bir fark gösterdi, ancak kısmi karbondioksit basıncının (pCO2) ortalamalarında göstermedi. Mortaliteyi tahmin etmede pH, anyon açığı, delta anyon açığı üstün tanısal güce sahipken (AUC>0.9), HCO3-, delta HCO3-, delta oranının kabul edilebilir tanı gücüne sahip olduğu (AUC: 0.7-0.8) bulundu.
Sonuç: Delta anyon açığı, delta bikarbonat ve delta oranı MZ olgularında mortaliteyi öngörmede prognostik faktörler olarak kullanılabilir.

Proje Numarası

The authors declare no any financial support.

Kaynakça

  • Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: two outbreaks, a single center experience. Alcohol. 2020;88:83-90.
  • Ashurst JV, Nappe TM. Methanol Toxicity. Treasure Island (FL), StatPearls Publishing, 2022.
  • Holt NR, Nickson CP. Severe methanol poisoning with neurological sequelae: implications for diagnosis and management. Intern Med J. 2018;48:335-9.
  • Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department. Emerg Med Pract. 2016;18:1-20.
  • Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3:208-25.
  • Zakharov S, Kurcova I, Navratil T, Salek T, Komarc M, Pelclova D. Is the measurement of serum formate concentration useful in the diagnostics of acute methanol poisoning? a prospective study of 38 patients. Basic Clin Pharmacol Toxicol. 2015;116:445-51.
  • Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med. 2004;30:1842-6.
  • Kraut JA, Madiast NE. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol. 2007;2:162-74.
  • Gallagher N, Edwards FJ. The diagnosis and management of toxic alcohol poisoning in the emergency department: a review article. Adv J Emerg Med. 2019;3:e28.
  • Kraut JA, Mullins ME. Toxic alcohols. N Engl J Med. 2018;378:270-80.
  • Kraut JA. Diagnosis of toxic alcohols: limitations of present methods. Clin Toxicol (Phila). 2015;53:589-95.
  • Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40:415-46.
  • Farwell WR, Taylor EN. Serum anion gap, bicarbonate and biomarkers of inflammation in healthy individuals in a national survey. CMAJ. 2010;182:137-41.
  • Feldman M, Soni N, Dickson B. Influence of hypoalbuminemia or hyperalbuminemia on the serum anion gap. J Lab Clin Med. 2005;146:317-20.
  • Rudkin SE, Grogan TR, Treger RM. The Δ anion gap/Δ bicarbonate ratio in early lactic acidosis: time for another delta? Kidney360. 2021;2:20.
  • Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15:625-32.
  • Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae – a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol. 2009;9:5.
  • Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia S. Prognostic factors in methanol poisoning. Hum Exp Toxicol. 2007;26:583-6.
  • Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P et al. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol (Phila). 2014;52:1013-24..
  • Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila). 2007;45:152-7.
  • Aghababaeian H, Ahvazi LA, Ostadtaghizadeh A. The methanol poisoning outbreaks in Iran 2018. Alcohol Alcohol. 2019;54:128-30.
  • WHO. Global Status Report on Alcohol and Health 2018. Geneva, World Health Organization, 2008.
  • Reddy P, Mooradian AD. Clinical utility of anion gap in deciphering acid–base disorders. Int J Clin Pract. 2009;63:1516-25.
  • Lipnick MS, Braun AB, Cheung JTW, Gibbons FK, Christopher KB. The difference between critical care initiation anion gap and prehospital admission anion gap is predictive of mortality in critical illness. Crit Care Med. 2013;41:49-59.
  • Xie K, Zheng C, Wang GM, Daio YF, Luo C, Wang E, et al. Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study. BMC Surg. 2022;22:186.
  • Zakharov S, Navrátil T, Pelclova D. Analysis of serum anion gap and osmolal gap in diagnosis and prognosis of acute methanol poisoning: clinical study in 86 patients. Monatshefte fur Chemie. 2015;146:787-94.
  • Arslan B, Akdağ D, Ünlü N, Arslan A, Açık V. The prognostic value of red cell distribution width for in-hospital mortality in patients with methanol poisoning. Hum Exp Toxicol. 2021;40:196-202.
  • Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes – a multicenter study. Clin Toxicol (Phila). 2012;50:823-31.
  • Persson HE, Sjöberg GK, Haines JA, De Garbino JP. Poisoning Severity Score: grading of acute poisoning. J Toxicol Clin Toxicol. 2009;36:205-13.
  • Casey PB, Dexter EM, Michell J, Vale JA. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol. 1998;36:215-7.
  • Zakharov S, Navratil T, Salek T, Kurcova I, Pelclova D. Fluctuations in serum ethanol concentration in the treatment of acute methanol poisoning: a prospective study of 21 patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159:666-76.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

Murat Duyan 0000-0002-6420-3259

Ali Sarıdaş 0000-0002-2725-6001

Nafis Vural 0000-0002-3551-201X

Proje Numarası The authors declare no any financial support.
Yayımlanma Tarihi 31 Mart 2023
Kabul Tarihi 9 Aralık 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 48 Sayı: 1

Kaynak Göster

MLA Duyan, Murat vd. “Delta Values As a Prognostic Marker in Methanol Poisoning: A Retrospective Cohort Study”. Cukurova Medical Journal, c. 48, sy. 1, 2023, ss. 46-53, doi:10.17826/cumj.1173429.