Predictors of poor outcome in mushroom poisoning: A retrospective cohort study
Keywords:Mushroom poisoning, Emergency department, Amanita Phalloides, Prognosis
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.
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