Abstract
Objective
This study was designed to determine the fatality rate of suspected cyclopeptide-containing mushroom ingestions reported to the National Poison Data System (NPDS).
Background
Although silibinin reportedly improves survival in suspected cyclopeptide-containing mushroom ingestions, the greater than 20% untreated fatality rate that is often cited is based on decades-old data. An ongoing open-label silibinin trial will likely use historical cases as comparators. A recent single poison control center (PCC) study showed a fatality rate of 8.3%. This study was designed to validate those findings in the NPDS.
Methods
This study was an 11-year (1/1/2008-12/31/2018) retrospective review of suspected cyclopeptide-containing mushroom ingestions reported to NPDS. Inclusion and exclusion criteria were the same as the ongoing silibinin trial: Age >2-years-old; history of eating foraged mushrooms; gastrointestinal symptoms within 48 h of mushroom ingestion; and aminotransferases above the upper limit of normal within 48 h after ingestion. Each original participating PCC confirmed eligibility, diagnosis, treatment, and outcome on included cases.
Results
During the study period, 8,953 mushroom exposures were reported to NPDS, of which 296 met inclusion criteria. The PCC survey response rate was 60% (28/47 PCCs), and the individual case response rate was 59% (174/296). Twenty-six cases were subsequently excluded leaving 148 included cases. The overall mortality rate was 8.8% (13/148). Mortality in silibinin/silymarin-treated vs untreated cases was 9.5% (4/42), vs 8.5% (9/106), respectively. A mycologist identified mushrooms in 16.9% of cases (25/148), of which 80% (20/25) were cyclopeptide-containing. Among these confirmed cases, the mortality rate was 10% (1/10) in both silibinin/silymarin-treated and untreated cases.
Conclusions
The contemporary mortality rate of patients with presumed cyclopeptide-mushroom poisoning is only 8.8%. This likely represents improved supportive care for patients with acute liver injury and should be considered the current standard for historical controls in the United States.
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Acknowledgements
The authors would like to thank the following PCCs who supplied data for this study:
Blue Ridge PCC
Central Ohio PCC
Children’s Hospital of Michigan Regional PCC (Detroit)
Cincinnati PCC
Connecticut PCC
Sacramento, CA, PCC
Georgia PCC
Illinois PCC
Indiana PCC
Iowa PCC
Jacksonville, FL, PCC
Minnesota PCC
Missouri PCC
National Capital PCC
Nebraska Regional PCC
New Jersey PCC
North Carolina PCC
North Texas PCC
New York City PCC
Oregon PCC
Palmetto PCC
PCC at Children’s Hospital of Philadelphia
San Diego, CA, PCC
Southeast Texas PCC
Tampa, FL, PCC
Upstate New York PCC
Virginia PCC
West Texas Regional PCC
Disclosure statement
No potential conflict of interest was reported by the author(s).