An early scoring system to predict mechanical ventilation for botulism: a single-center-based study  

作　　者：Yaqing An Tuokang Zheng Yanling Dong Yang Wu Yu Gong Yu Ma Hao Xiao Hengbo Gao Yingping Tian Dongqi Yao 

机构地区：[1]Emergency Department,the Second Hospital of Hebei Medical University,Shijiazhuang 050051,China

出　　处：《World Journal of Emergency Medicine》2024年第5期365-371,共7页世界急诊医学杂志（英文）

基　　金：funded by the Medical Science Research Project of Hebei Provincial Health and Health Commission(20221073).

摘　　要：BACKGROUND: Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism. The present study aimed to establish a new scoring system to predict mechanical ventilation(MV) for botulism patients.METHODS: A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022. Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system. The area under the receiver operating characteristic(ROC) curve was calculated.RESULTS: A total of 153 patients with botulism(66 males and 87 females, with an average age of 43 years) were included. Of these, 49 patients(32.0%) required MV, including 21(13.7%) with invasive ventilation and 28(18.3%) with non-invasive ventilation. Multivariate analysis revealed that botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement were independent risk factors for MV. These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system. Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A: 1], [pneumonia: 2], [incubation period ≤1 day: 2], [hypoxia <90%: 2], [severity of muscle involvement: grade Ⅱ, 3;gradeⅢ, 7;grade IV, 11]). The scoring system achieved an area under the ROC curve of 0.82(95% CI 0.75–0.89, P<0.001). At the optimal threshold of 9, the scoring system achieved a sensitivity of 83.7% and a specificity of 70.2%.CONCLUSION: Our study identified botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement as independent risk factors for MV in botulism patients. A score ≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients. This scoring system needs to be validated externall

关 键 词：BOTULISM Scoring system Botulinum toxin type Incubation period HYPOXIA PNEUMONIA Severity of muscle involvement 

分 类 号：R459.7[医药卫生—急诊医学]