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

Abstract

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.

• Authors: Sergey Zakharov, Jan Rulisek, Jiri Hlusicka, Katerina Kotikova, Tomas Navratil, Martin Komarc, Manuela Vaneckova, Zdenek Seidl, Pavel Diblik, Jan Bydzovsky, Jarmila Heissigerova, David Zogala, Jaroslav A Hubacek, Michal Miovsky, Jaroslav Sejvl, Lucie Vojtova, Daniela Pelclova
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 58 Issue 4 Pg. 241-253 (04 2020) ISSN: 1556-9519 [Electronic] England
• PMID: 31298045 (Publication Type: Journal Article)

Chemical References

• Formaldehyde
• Methanol

Topics

• Adolescent
• Adult
• Cohort Studies
• Disease Outbreaks (statistics & numerical data)
• Female
• Follow-Up Studies
• Formaldehyde (metabolism, poisoning)
• Hospital Mortality
• Hospitalization (statistics & numerical data)
• Humans
• Longitudinal Studies
• Male
• Methanol (pharmacokinetics, poisoning)
• Middle Aged
• Poisoning (epidemiology, mortality)
• Prospective Studies
• Risk Factors
• Survival Rate
• Young Adult