Metanol zehirlenmesi olan hastalarda mortalite ile ilişkili risk faktörleri: retrospektif bir çalışma

Yıl 2022, , 293 - 300, 31.12.2022

Hakan Aydın , Fatih Doğanay , Mehmet Erdoğan , Halil Doğan , Attila Beştemir , Alpay Tuncar

https://doi.org/10.30565/medalanya.1184894

Cited By: 2

Öz

Amaç: Metanol zehirlenmesi (MZ) dünya çapında önemli bir tıbbi sorundur, tanı ve tedavideki gelişmelere rağmen bu vakalarda ölüm oranı yüksektir. Bu çalışmada MZ olan hastalarda hastane içi mortaliteyi öngörmek için klinik ve laboratuvar faktörlerinin değerlendirilmesi amaçlandı.

Yöntemler: Bu tek merkezli, retrospektif, gözlemsel çalışma, 01 Ocak 2017 ve 01 Şubat 2022 tarihleri arasında üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisini (AS) ziyaret eden yetişkin 65 MZ vakası ile yürütülmüştür. Veriler hayatta olanlar ve hayatta olmayanlar arasında istatistiksel olarak karşılaştırıldı.

Bulgular: Hastane içi ölüm oranı %41,5 idi. Hayatta kalmayanlar grubunda solunum sıkıntısı, düşük GKS (≤8), ve hastaneye geç başvuran (24 saaten sonra) vakalarının oranı, hayatta kalanlar grubuna göre daha yüksekti. Ölen hastaların grubunda yaşayanlara kıyasla daha yüksek anyon açığı (30,5 mEq/L vs. 25,5mEq/L), baz fazlalığı (-25,0 mmol/L vs. -18,6 mmol/L), laktat seviyeleri (10,2 mmol/L vs. 2,2 mmol/L) ve daha düşük pH (6,76 vs. 7,14) ve bikarbonat (6,3 mmol/L vs. 10,3 mmol/L) seviyeleri vardı (p<0.001). ROC analizinde pH (AUC= 0,916) ve baz fazlalığı (AUC=0,915), MZ olgularında mortaliteyi öngörmede en yüksek AUC değerlerine sahip kan gazı parametreleriydi. Tedavide folat kullanımının mortalite üzerinde istatistiksel olarak anlamlı bir etkisi oldu (p=0.015). Tedavide folat kullanımının mortalite üzerinde istatistiksel olarak anlamlı bir etkisi oldu (p=0.015).

Sonuç: MZ olgularında hastaneye başvuruda geçikme, şiddetli metabolik asidoz, yüksek laktat düzeyleri, acil servise gelişte düşük GKS ve folat tedavisiverilmemesi, artan hastane içi mortalite oranları ile ilişkiliydi. Verilerimiz MZ hastalarının klinik yönetimine ve tedavi protokollerinin geliştirilmesine katkıda bulunacaktır

Anahtar Kelimeler

Methanol, Folik asid, Asidoz, Anyon açığı, Alkol zehirlenmesi

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Risk factors associated with mortality in patients with methanol poisoning: a retrospective study

Öz

Aim: Methanol poisoning (MP) is an significant medical problem worldwide, and despite advances in diagnosis and treatment, the mortality rate in these cases remains high. This study aimed to evaluate the clinical and laboratory factors to determine in-hospital mortality in patients with MP.

Methods: This single-center, retrospective, observational study was conducted with 65 adult MP cases visiting the emergency department (ED) of a tertiary training and research hospital, between January 01, 2017 and February 01, 2022. Data was statistically compared between survivors and non-survivors.

Results: The in-hospital mortality rate was 41.5%. The rate of cases with respiratory distress, low Glasgow coma scale (GCS) (≤8), and delayed arrival to the hospital (>24 hours) was higher in the group of non-survivors compared to the group of survivors. Non-survivors had a higher anion gap (30.5 mEq/L vs. 25.5mEq/L), base excess (-25.0 mmol/L vs. -18.6 mmol/L), lactate (10.2 mmol/L vs. 2.2 mmol/L) levels, and lower pH (6.76 vs. 7.14) and bicarbonate (6.3 mmol/L vs. 10.3 mmol/L) levels than survivors (p<0.001). In ROC analysis, pH (AUC= 0.916) and base excess (AUC=0.915) were blood gas parameters with the highest AUC values in predicting mortality in MP cases. Folate use in the treatment had a statistically significant effect on mortality (P=0.015).

Conclusion: In MP cases, delay in a hospital visit, severe metabolic acidosis, high lactate levels, low GCS on arrival to the ED and no folate therapy, were associated with increased in-hospital mortality rates. Our data will contribute to the clinical management of MP patients and the development of treatment protocols.

Anahtar Kelimeler

Methanol, Folic Acid, Acidosis, Anion gap, Alcoholic Intoxication

Proje Numarası

Yok

Kaynakça

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