Journal of forensic and legal medicine · 2026
APACHE II score as a predictor of mortality following acute paraquat poisoning: A retrospective cohort study.
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Hanumanthappa Mohan Kumar, Vaid Aarti, Sharda Saurabh C, Behera Ashish, Muthu Valliappan, Sharma Navneet
Аннотация
BACKGROUND: Paraquat poisoning carries a high mortality rate. The absence of an effective treatment and standardised prognostic tools necessitates a robust, accessible method for early risk stratification. This study aimed to evaluate whether the baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) score can predict seven-day mortality in patients with acute paraquat poisoning and distinguish survivors from non-survivors.
METHODS: In this retrospective cohort study, 98 patients with confirmed paraquat poisoning admitted between January 2014 and December 2023 were included. Demographic, clinical, and laboratory data, including APACHE II scores, were extracted from medical records. Seven-day outcomes were compared using univariate and multivariable logistic regression analyses. ROC analysis was performed to assess the discriminative ability of the APACHE II score, and the optimal cut-off was determined using Youden's index.
RESULTS: The seven-day mortality rate was 55.1% (54/98). Non-survivors exhibited significantly higher median APACHE II scores than survivors (10 vs. 8; p = 0.005). In multivariable analysis, the APACHE II score independently predicted mortality (OR, 1.16; 95% CI, 1.02-1.35; p = 0.030), along with elevated serum bilirubin levels (OR, 1.12; 95% CI, 1.02-1.24; p = 0.030). ROC analysis revealed an AUC of 0.675, and Youden's index identified an optimal APACHE II cut-off of 6.5, yielding a sensitivity of 88% and a specificity of 39.5%.
CONCLUSION: The baseline APACHE II score effectively and independently predicts early mortality in paraquat poisoning. However, its modest discriminative performance, particularly the low specificity of 39.5% and the retrospective design of this study are important limitations. Further prospective multicentre validation studies and integration with other clinical tools may enhance early risk stratification and support prompt clinical decision-making, particularly when specialised assays are unavailable.
METHODS: In this retrospective cohort study, 98 patients with confirmed paraquat poisoning admitted between January 2014 and December 2023 were included. Demographic, clinical, and laboratory data, including APACHE II scores, were extracted from medical records. Seven-day outcomes were compared using univariate and multivariable logistic regression analyses. ROC analysis was performed to assess the discriminative ability of the APACHE II score, and the optimal cut-off was determined using Youden's index.
RESULTS: The seven-day mortality rate was 55.1% (54/98). Non-survivors exhibited significantly higher median APACHE II scores than survivors (10 vs. 8; p = 0.005). In multivariable analysis, the APACHE II score independently predicted mortality (OR, 1.16; 95% CI, 1.02-1.35; p = 0.030), along with elevated serum bilirubin levels (OR, 1.12; 95% CI, 1.02-1.24; p = 0.030). ROC analysis revealed an AUC of 0.675, and Youden's index identified an optimal APACHE II cut-off of 6.5, yielding a sensitivity of 88% and a specificity of 39.5%.
CONCLUSION: The baseline APACHE II score effectively and independently predicts early mortality in paraquat poisoning. However, its modest discriminative performance, particularly the low specificity of 39.5% and the retrospective design of this study are important limitations. Further prospective multicentre validation studies and integration with other clinical tools may enhance early risk stratification and support prompt clinical decision-making, particularly when specialised assays are unavailable.