Clinical features of acute glufosinate ammonium and initial serum ammonia and CK-MB as early predictors of unfavorable prognosis

This retrospective study was conducted on 67 patients who suffered from acute oral glufosinate ammonium poisoning to summarize a comprehensive overview of the clinical characteristics. General clinical data and laboratory test results were collected from the time of admission to hospital discharge. The most common clinical symptom of GA poisoning were nausea and vomiting, The incidence of unfavorable outcomes and the mortality of GA poisoning were 41.8% and 13.4%. The unfavorable outcomes group had a higher initial serum ammonia level (75.7±17.3umol/L vs 47.5±12.8umol/L, P<0.001), more ingestion amount of GA (103.6±63.4ml vs 72.3±37.7ml, P=0.032) and higher-level CK-MB (43.5 U/L vs 16.0 U/L, P=0.002) compared to favorable outcomes groups. Multiple logistic regression analyses showed the initial serum ammonia (OR=1.031, 95%CI, 1.069-1.197, P<0.001)，ingestion amount of GA (OR=1.017, 95%CI, 0.997-1.039, P=0.013) and CK-MB (OR=1.017, 95%CI, 0.997-1.039, P=0.013) levels were independently associated with unfavorable outcomes. Receive operator characteristic (ROC) curves were used to determine the optimal initial serum ammonia level (62.7mmol/L with sensitivity of 85.7% and specificity of 87.2%, and AUC=0.873, 95%CI, 0.773-0.974, P<0.001), CK-MB level (43.5U/L with sensitivity of 42.9% and specificity of 87.2%, and AUC=0.680, 95%CI, 0.562-0.809, P=0.012) and the ingestion amount(110ml with sensitivity of 32.1% and specificity of 92.3%, and AUC=0.652, 95%CI, 0.518-0.786, P=0.035) respectively.The patients with GA poisoning may exhibit clinical symptoms of gastrointestinal and neurological toxicity, as well as respiratory failure after latent period that we need to pay special attention to prepare. Initial serum and CK-MB might be better accurate prognostic factors for predicting the unfavorable outcomes.