Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2017; 23(7): 1262-1267
Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1262
Predictors of poor outcomes in patients with wild mushroom-induced acute liver injury
Taerim Kim, Danbi Lee, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
Taerim Kim, Jae Ho Lee, Yoon-Seon Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Danbi Lee, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Lee JH, Lee YS, Oh BJ, Lim KS and Kim WY designed the research; Lee D performed the research; Kim T collected data; Kim WY analyzed data; Kim T and Kim WY wrote the paper; all authors have read and approved the final version to be published.
Institutional review board statement: Based on the Declaration of Helsinki, Asan Medical Center Institutional Review Board approved the retrospective use of the clinical, biochemical, and radiographic data for the present study.
Informed consent statement: The requirements for informed consent were waived due to the retrospective design.
Conflict-of-interest statement: The authors declare they have no potential conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Won Young Kim, MD, PhD, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. wonpia73@naver.com
Telephone: +82-2-30103350 Fax: +82-2-30103360
Received: November 7, 2016
Peer-review started: November 7, 2016
First decision: December 19, 2016
Revised: January 2, 2017
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 21, 2017
Abstract
AIM

To identify early predictive markers of poor outcomes in patients with acute liver injury from wild mushroom intoxication.

METHODS

This observational, retrospective record review involved adults aged ≥ 18 years admitted to emergency department with mushroom intoxication from January 2005 to December 2015. The diagnosis of mushroom intoxication was based on the following: (1) a positive history of recent wild mushroom intake (either raw or cooked); (2) the onset of gastrointestinal symptoms, such as watery diarrhea, vomiting, and/or abdominal pain, after ingestion; and (3) the exclusion of other possible causes of acute liver injury. Acute liver injury was defined by a > 5-fold elevation of liver enzymes or moderate coagulopathy [international normalized ratio (INR) > 2.0]. Clinical and laboratory findings were compared in survivors and non-survivors.

RESULTS

Of 93 patients with mushroom intoxication, 23, 11 men (47.8%) and 12 women (52.2%), of median age 61 years, developed acute liver injury. The overall in-hospital mortality rate was 43.5% (10/23). Among the laboratory variables, mean serum alkaline phosphatase (73.38 ± 10.89 mg/dL vs 180.40 ± 65.39 mg/dL, P < 0.01), total bilirubin (2.312 ± 1.16 mg/dL vs 7.16 ± 2.94 mg/dL, P < 0.01) concentrations and indirect/direct bilirubin (2.45 ± 1.39 mg/dL vs 0.99 ± 0.45 mg/dL, P < 0.01) ratio as well as prothrombin time (1.88 ± 0.83 mg/dL vs 10.43 ± 4.81 mg/dL, P < 0.01), and activated partial thromboplastin time (aPTT; 32.48 ± 7.64 s vs 72.58 ± 41.29 s, P = 0.01), were significantly higher in non-survivors than in survivors. Logistic regression analysis showed that total bilirubin concentration (OR = 3.58, 95%CI: 1.25-10.22), indirect/direct bilirubin ratio (OR = 0.14, 95%CI: 0.02-0.94) and aPTT (OR = 1.30, 95%CI: 1.04-1.63) were significantly associated with mortality. All patients with total bilirubin > 5 mg/dL or aPTT > 50 s on day 3 died.

CONCLUSION

Monitoring of bilirubin concentrations and aPTT may help in predicting clinical outcomes in patients with acute liver injury from wild mushroom intoxication.

Keywords: Mushroom, Liver, Outcome, Intoxication, Bilirubin

Core tip: Wild mushroom-induced acute liver failure is potentially fatal. Many candidates for liver transplantation progress to multi-organ failure resulting in deterioration while awaiting liver transplantation. Identifying early predictive markers of poor outcomes in patients with acute liver injury resulting from wild mushroom intoxication is critical for improving survival rates. Total bilirubin and activated partial thromboplastin time (aPTT) levels were associated with in-hospital mortality in patients with acute liver injury from wild mushroom intoxication. Monitoring total bilirubin and aPTT as predictors of survival outcomes may determines the need for advanced intervention such as liver transplantation.