The impact of co-morbidities on a 6-year survival after methanol mass poisoning outbreak: possible role of metabolic formaldehyde

0507581 - ÚFCH JH 2021 RIV US eng J - Journal Article
Zakharov, S. - Rulíšek, J. - Hlušička, J. - Kotíková, K. - Navrátil, Tomáš - Komarc, M. - Vaněčková, M. - Seidl, Z. - Diblík, P. - Bydžovský, J. - Heissigerová, J. - Zogala, D. - Hubáček, J. A. - Miovský, M. - Šejvl, J. - Vojtová, L. - Pelclová, D.
The impact of co-morbidities on a 6-year survival after methanol mass poisoning outbreak: possible role of metabolic formaldehyde.
Clinical Toxicology. Roč. 58, č. 4 (2020), s. 241-253. ISSN 1556-3650. E-ISSN 1556-9519
Institutional support: RVO:61388955
Keywords : Acute methanol poisoning * co-morbidities * complications * follow-up mortality * formaldehyde * hospital mortality * prognosis
OECD category: Physical chemistry
Impact factor: 4.467, year: 2020
Method of publishing: Open access

Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known. Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality. Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan–Meier method. Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years, p =.159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years, p =.044) survived. The hospital mortality was 22%, the follow-up mortality was 18%. The total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p <.05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22, 1.00–1.48 95% CI, p =.046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan–Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p =.027) or moderate (p =.020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths. Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation.
Permanent Link: http://hdl.handle.net/11104/0298569