Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department

Association of glyphosate exposure with frailty and all-cause mortality in general adults: A population-based cohort study

BACKGROUND

Glyphosate is the most widely used herbicide globally. However, its association with frailty, an emerging public health concern, and mortality in the general population remains unclear.

METHODS

This cohort utilized the National Health and Nutrition Examination Survey (NHANES) 2013-2018 data, with follow-up through December 31, 2019. Weighted logistic regression, Cox regression, and restricted cubic splines analyses were performed to investigate the association of urinary glyphosate with frailty, defined using a 49-item frailty index at baseline, and all-cause mortality, respectively. Causal mediation analysis and sensitivity analysis were also employed.

RESULTS

4697 adults (mean age: 47.1 years; 48.9 % male) were included. Multivariable logistic regression showed that elevated urinary glyphosate correlated with increased frailty prevalence (log2-transformed, adjusted OR = 1.14, 95 % CI: 1.04-1.25; quartiles, P for trend = 0.002), with a linear dose-response relationship (P value for nonlinearity = 0.568). During a median follow-up of 3.9 years, 238 total deaths occurred. Multivariable-adjusted Cox regression demonstrated that urinary glyphosate was positively related to all-cause mortality (log2-transformed, adjusted HR = 1.19, 95 % CI: 1.07-1.31; quartiles, P for trend = 0.005). Additionally, frailty significantly mediated the association between glyphosate and all-cause mortality, with mediation proportion of 30.3 %.

CONCLUSIONS

Urinary glyphosate was positively associated with frailty and all-cause mortality in the general US adult population. Frailty also played a partial mediator role in this relationship. These findings provide new evidence of adverse health effects of glyphosate and imply that enhanced efforts should be made to mitigate exposure to glyphosate.

A Comparative Analysis of Toxicology and Non-Toxicology Care in Intoxicated Patients with Acute Kidney Injury

Background and Objectives: Intoxicated patients with acute kidney injury (AKI) experience high morbidity and mortality. While prior studies suggest that toxicology care settings improve outcomes, the impact of care settings on patients with AKI remains unclear. This study aimed to compare the outcomes of intoxicated patients with AKI managed in toxicology versus non-toxicology care settings. Materials and Methods: This retrospective cohort study included intoxicated patients admitted to a tertiary hospital between January 2022 and December 2023. Patients were categorized into toxicology and non-toxicology care settings. Demographic characteristics, clinical outcomes focusing on mortality and length of hospital stay, and evaluation scores were compared. Results: A total of 31 intoxicated patients with AKI were included in the study. There were no significant differences in mortality or hospital length of stay between toxicology and non-toxicology care settings. However, the mortality rate in the AKI group was significantly higher (16%) compared to intoxicated patients without AKI (1.9%). Additionally, hospital stays were consistently longer in the AKI group than in the non-AKI group across all age groups. Conclusions: Hospital length of stay and mortality did not differ significantly between toxicology and non-toxicology care settings for intoxicated patients with AKI. However, both hospital length of stay and mortality were notably higher in patients with AKI compared to those without AKI.

Clinical toxicology of acute glyphosate self-poisoning: impact of plasma concentrations of glyphosate, its metabolite and polyethoxylated tallow amine surfactants on the toxicity

INTRODUCTION

Common major co-formulants in glyphosate-based herbicides, polyethoxylated tallow amine surfactants, are suspected of being more toxic than glyphosate, contributing to the toxicity in humans. However, limited information exists on using polyethoxylated tallow amine concentrations to predict clinical outcomes. We investigated if plasma concentrations of glyphosate, its metabolite and polyethoxylated tallow amines can predict acute kidney injury and case fatality in glyphosate poisoning.

METHODS

We enrolled 151 patients with acute glyphosate poisoning between 2010 and 2013. Plasma concentrations of glyphosate, its metabolite, aminomethylphosphonic acid, and polyethoxylated tallow amines were determined in 2020 using liquid chromatography-tandem mass spectrometry. Associations between exposure and poisoning severity were assessed.

RESULTS

Plasma concentrations of glyphosate and aminomethylphosphonic acid demonstrated good and moderate performances in predicting acute kidney injury (≥2), with an area under the receiver operating characteristic curve of 0.83 (95% CI 0.69-0.97) and 0.76 (95% CI 0.59-0.94), respectively. Polyethoxylated tallow amines were detected in one-fifth of symptomatic patients, including one of four fatalities and those with unsaturated tallow moieties being good indicators of acute kidney injury (area under the receiver operating characteristic curve ≥0.7). As the number of repeating ethoxylate units in tallow moieties decreased, the odds of acute kidney injury increased. Glyphosate and aminomethylphosphonic acid concentrations were excellent predictors of case fatality (area under the receiver operating characteristic curve >0.9).

DISCUSSION

The 2.7% case fatality rate with 49% acute, albeit mild, acute kidney injury following glyphosate poisoning is consistent with previously published data. A population approach using model-based metrics might better explore the relationship of exposure to severity of poisoning.

CONCLUSIONS

Plasma concentrations of glyphosate and its metabolite predicted the severity of clinical toxicity in glyphosate poisoning. The co-formulated polyethoxylated tallow amine surfactants were even more strongly predictive of acute kidney injury but were only detected in a minority of patients.

Human poisoning with glyphosate-surfactant herbicides: Retrospective analysis of mortality outcomes of patients treated in a poison center

INTRODUCTION

The toxicity and carcinogenicity of glyphosate have long been debated. Nevertheless, the mortality rate in patients with acute glyphosate-surfactant poisoning varies across different groups.

METHODS

Between 2002 and 2020, 109 patients with glyphosate-surfactant poisoning received treatment at Chang Gung Memorial Hospital. Patients were stratified into two subgroups according to their prognosis: good (n = 74) or poor (n = 35). Baseline demographics, psychiatric comorbidities, medical complications, and laboratory data were collected, and mortality data were analyzed.

RESULTS

The patients were 54.1 ± 17.5 years of age and were mostly male (68.8%). Most patients (91.7%) ingested pesticides intentionally, and patients arrived at the hospital within 7.1 ± 12.7 h. Psychiatric comorbidities were prevalent, and the top three comorbidities were mental (71.6%), depressive (48.6%), and adjustment (14.7%) disorder. Patients with poor prognoses were older than those with good prognoses (p = .007). Moreover, patients with poor prognoses had lower Glasgow Coma Scale scores (p < .001) and diastolic blood pressure (p = .008), but higher incidences of upper gastrointestinal bleeding (p < .001), aspiration pneumonia (p < .001), hypotension (p < .001), hyperglycemia (p = .002), acute kidney injury (p < .001), and metabolic acidosis (p < .001) than patients with good prognoses. The mortality rate was 5.5%. A multivariate-logistic-regression model revealed that the Glasgow Coma Scale score was a significant risk factor for poor prognosis (odds ratio 0.653, confidence interval 0.427-0.998; p = .049). However, no risk factors for mortality were identified.

CONCLUSIONS

A total of 32.1% of patients with glyphosate-surfactant poisoning had poor prognoses, and 5.5% of patients died despite treatment. The mortality outcome is comparable to that of published reports from other international poison centers.

Emergency mortality of non-trauma patients was predicted by qSOFA score

Objective

This study was aimed to evaluate the performance of quick sequential organ failure assessment (qSOFA) in predicting the emergency department (ED) mortality of non-trauma patients and to expand the application scope of qSOFA score.

Methods

A single, retrospective review of non-trauma patients was conducted in ED between November 1, 2016 and November 1, 2019. The qSOFA score was obtained from vital signs and Glasgow Coma Scale (GCS) score. The outcome was ED mortality. Multivariable logistic regression analysis was performed to explore the association between the qSOFA score and ED mortality. The area under the receiver operating characteristic (AUROC) curve, the best cutoff value, sensitivity and specificity were performed to ascertain the predictive value of the qSOFA score.

Results

228(1.96%) of the 11621 patients were died. The qSOFA score was statistically higher in the non-survival group (P<0.001). The qSOFA score 0 subgroup was used as reference baseline, after adjusting for gender and age, adjusted OR of 1, 2 and 3 subgroups were 4.77 (95%CI 3.40 to 6.70), 18.17 (95%CI 12.49 to 26.44) and 23.63 (95%CI 9.54 to 58.52). All these three subgroups show significantly higher ED mortality compared to qSOFA 0 subgroup (P<0.001). AUROC of qSOFA score was 0.76 (95% CI 0.73 to 0.79). The best cutoff value was 0, sensitivity was 77.63% (95%CI 71.7% to 82.9%), and specificity was 67.2% (95%CI 66.3% to 68.1%).

Conclusion

The qSOFA score was associated with ED mortality in non-trauma patients and showed good prognostic performance. It can be used as a general tool to evaluate non-trauma patients in ED. This is just a retrospective cohort study, a prospective or a randomized study will be required.

The use of combined high-fructose diet and glyphosate to model rats type 2 diabetes symptomatology

An ideal food-chemical combination that will promote insulin resistance and its consequent development of pancreatic beta-cell dysfunction may open a new vista for Type 2 diabetes (T2D) research. Thus, we investigated the modulatory effects of a high-fructose diet (FRC) combined with glyphosate (GP). Male albino Wistar rats were randomly divided into five groups of eight/group and received distilled water, FRC, GP, and their combinations orally for eight consecutive weeks. We assessed the changes in fasting blood glucose levels (FBGLs), biochemical indices, oxidative stress parameters, and organ histopathology. From the results obtained, FBGLs and serum insulin levels were increased in the FRC-GP (2.3-3.1 and 1.9-2.2 folds) treated rats compared with the control baseline group. Also, the FRC-GP high dose increased FBGLs (1.9 folds), insulin (1.4 folds), triglycerides (1.5 folds), and uric acid (2 folds) levels compared with the FRC group. Malondialdehyde levels increased in the pancreas (54% and 78%) and liver (31.3% and 56.6%) of the FRC-GP treated rats. The FRC-GP treatments reduced serum high-density lipoprotein (57%), total protein (47%), and antioxidant parameters (non-enzymatic and enzymatic, 1.6-1.9 folds) respectively in the treated animals. The weight of the pancreas relative to the body increased (2-3 folds) while we observed mild inflammation and vascular congestion in vital organs in the treated rats. Overall, these results demonstrate the potential of FRC-GP-diet to induce conditions of rats T2D. Also, this novel finding suggests a cost-effective GP as an alternative in this model type and provides further insight into understanding FRC-GP interactions.

Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department

Background

A prediction model of mortality for patients with acute poisoning has to consider both poisoning-related characteristics and patients’ physiological conditions; moreover, it must be applicable to patients of all ages. This study aimed to develop a scoring system for predicting in-hospital mortality of patients with acute poisoning at the emergency department (ED).

Methods

This was a retrospective analysis of the Injury Surveillance Cohort generated by the Korea Center for Disease Control and Prevention (KCDC) during 2011–2018. We developed the new-Poisoning Mortality Scoring system (new-PMS) to generate a prediction model using the derivation group (2011–2017 KCDC cohort). Points were computed for categories of each variable. The sum of these points was the new-PMS. The validation group (2018 KCDC cohort) was subjected to external temporal validation. The performance of new-PMS in predicting mortality was evaluated using area under the receiver operating characteristic curve (AUROC) for both the groups.

Results

Of 57,326 poisoning cases, 42,568 were selected. Of these, 34,352 (80.7%) and 8216 (19.3%) were enrolled in the derivation and validation groups, respectively. The new-PMS was the sum of the points for each category of 10 predictors. The possible range of the new-PMS was 0–137 points. Hosmer–Lemeshow goodness-of-fit test showed adequate calibration for the new-PMS with p values of 0.093 and 0.768 in the derivation and validation groups, respectively. AUROCs of the new-PMS were 0.941 (95% CI 0.934–0.949, p < 0.001) and 0.946 (95% CI 0.929–0.964, p < 0.001) in the derivation and validation groups, respectively. The sensitivity, specificity, and accuracy of the new-PMS (cutoff value: 49 points) were 86.4%, 87.2%, and 87.2% and 85.9%, 89.5%, and 89.4% in the derivation and validation groups, respectively.

Conclusions

We developed a new-PMS system based on demographic, poisoning-related variables, and vital signs observed among patients at the ED. The new-PMS showed good performance for predicting in-hospital mortality in both the derivation and validation groups. The probability of death increased according to the increase in the new-PMS. The new-PMS accurately predicted the probability of death for patients with acute poisoning. This could contribute to clinical decision making for patients with acute poisoning at the ED.