Predictors of acute kidney injury after paraquat intoxication

// Cheng-Hao Weng 1, * , Hui-Hsiang Chen 1, * , Ching-Chih Hu 2 , Wen-Hung Huang 1 , Ching-Wei Hsu 1 , Jen-Fen Fu 3 , Wey-Ran Lin 4 , I-Kwan Wang 5 and Tzung-Hai Yen 1, 6, 7 1 Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan 2 Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan 3 Department of Medical Research, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan 4 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan 5 Department of Nephrology, Chang Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan 6 Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan 7 Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan * These authors contributed equally to this work Correspondence to: Tzung-Hai Yen, email: m19570@adm.cgmh.org.tw Keywords: paraquat, suicide, acute kidney injury, SOFA, AKIN Received: March 14, 2017      Accepted: May 07, 2017      Published: May 18, 2017 ABSTRACT Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI ( n = 103) and non-AKI ( n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival ( P = 0.003), lower PaO 2 ( P = 0.006) and higher alveolar-arterial O 2 difference ( P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score ( P < 0.001), higher severity index of paraquat poisoning (SIPP) score ( P = 0.016), lower PaCO 2 at admission ( P = 0.031), higher PaO 2 at admission ( P = 0.015), lower nadir PaCO 2 ( P = 0.001) and lower nadir HCO 3 ( P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis ( P < 0.001), a longer time to hospital arrival ( P < 0.001), higher SIPP score ( P = 0.026) and higher PaO 2 at admission ( P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO 2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.