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Potential value of urinary amatoxin quantification in patients with hepatotoxic mushroom poisoning
Ona Escoda1, Enric Reverter2, Jordi To-Figueras3
1Emergency Department, Hospital Clínic, Barcelona, Spain.
Backgorund & Aims:
Mushroom poisoning with Amanita phalloides or similar species can lead to liver failure with 10-30% mortality rates. We aimed at defining the prognostic value of urinary amatoxin quantification in patients with hepatotoxic mushroom poisoning.
Methods:
Data from 32 patients with hepatotoxic mushroom poisoning (Hospital Clínic Barcelona, 2002-16) in whom urinary amatoxins were determined (ELISA) were retrospectively reviewed. Correlations between urinary amatoxin and collected baseline variables with outcomes including hepatotoxicity (ALT>1000 U/L), severe acute liver injury (ALI, prothrombin <50%), acute liver failure (ALF, ALI and encephalopathy), transplantation/death and hospital length-of-stay, were evaluated.
Results:
12/32 patients developed increased aminotransferase activity. Among the 13/32 amatoxin negative patients, 1 developed ALI and 12/13 no hepatotoxicity. Among the 19/32 amatoxin positive patients, 8/19 (42%) developed hepatotoxicity, including 5 who progressed to severe ALI, of whom 3 developed ALF (2 deaths, 1 transplantation). Urinary amatoxin and prothrombin were independent predictors of hepatotoxicity, ALT peak values (along with age) and hospital length-of-stay. In positive amatoxins patients, urinary concentrations > 55 ng/ml (or a baseline prothrombin ≤ 83%), were associated to hepatotoxicity (presented by 8/9 patients with ALT>1000 U/L). Among 5 patients with urinary amatoxin ≥ 70 ng/ml, 4 developed severe ALI.
Conclusions:
In patients with hepatotoxic mushroom poisoning, a negative urinary amatoxin quantification within 72h of intake ruled out the risk of hepatotoxicity in 92% of patients, whereas positive urinary amatoxins were associated with hepatotoxicity and severe ALI. Concentrations >55 ng/ml and ≥ 70 ng/ml were predictive of hepatotoxicity and severe ALI, respectively.
Insights
Urinary amatoxin testing can predict liver damage from mushroom poisoning. Negative results within 72 hours rule out toxicity, while positive results indicate a high risk of severe liver injury.
Area of Science:
- Toxicology
- Hepatology
- Clinical Chemistry
Background:
- Mushroom poisoning, particularly from Amanita phalloides, poses a significant risk of liver failure with considerable mortality.
- Accurate prognostic markers are crucial for managing hepatotoxic mushroom ingestions.
Purpose of the Study:
- To evaluate the prognostic value of quantifying urinary amatoxins in patients with mushroom-induced liver injury.
- To correlate urinary amatoxin levels with clinical outcomes such as hepatotoxicity and acute liver failure.
Main Methods:
- Retrospective analysis of 32 patients with hepatotoxic mushroom poisoning.
- Urinary amatoxin levels were measured using ELISA.
- Correlations were assessed between urinary amatoxin concentrations, baseline variables, and clinical outcomes.
Main Results:
- 19 patients tested positive for urinary amatoxins, with 42% developing hepatotoxicity, including severe acute liver injury (ALI) and acute liver failure (ALF).
- Negative urinary amatoxin tests (within 72h) ruled out hepatotoxicity in 92% of cases.
- Urinary amatoxin levels >55 ng/ml predicted hepatotoxicity, and levels ≥70 ng/ml predicted severe ALI.
Conclusions:
- Urinary amatoxin quantification is a valuable tool for assessing prognosis in hepatotoxic mushroom poisoning.
- A negative test within 72 hours is highly reliable for excluding significant liver injury.
- Positive tests, especially with higher concentrations, strongly correlate with severe liver damage and adverse outcomes.
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