Clinical characteristics and outcome of toxicity from Amanita mushroom poisoning

Figures & data

Table 1 Baseline characteristics of the patients

Characteristics	Number of patients
Gender
Male	28 (50.9%)
Female	27 (49.1%)
Age (year), mean ± SD	43.85 ± 21.65
Region
North/east	39 (71%)
North	7 (12.7%)
West	6 (10.9%)
East	2 (3.6%)
Central	1 (1.8%)
Underlying diseases
No	46 (83.6%)
Yes	9 (16.4%)
The onset of GI symptoms after consuming mushrooms (hours), median (min–max)	9 (0.5–24)
Time between consumption of mushrooms and hospital admission (51 cases)
Within 24 hours	19 (37.3%)
More than 24 hours	32 (62.7%)
Admitted to the hospital
Yes	51 (92.7%)
No	4 (7.3%)

Abbreviations: SD, standard deviation; GI, gastrointestinal; min, minimum; max, maximum.

Table 2 The clinical features of the patients during the hospitalization

Clinical features (total cases recorded)	Number of patients (%)
Hepatitis (50 cases)	37 (74%)
AKI (54 cases)	25 (46.3%)
Jaundice (47 cases)	21 (44.7%)
Coagulopathy (36 cases)	19 (52.8%)
Elevated indirect bilirubin (>50% of total) (48 cases)	13 (27%)
Bleeding (all had GI bleeding) (53 cases)	12 (22.6%)
Hepatic encephalopathy (53 cases)	11 (20.8%)

Abbreviations: AKI, acute kidney injury; GI, gastrointestinal.

Table 3 Laboratory findings of all patients

Laboratory finding	Results
Initial AST results (IU/L), median (min-max)	159.5 (18–12,592)
Max AST results (IU/L), median (min–max)	871 (18–12,592)
Initial ALT results (IU/L), median (min–max)	122 (12–18,871)
Max ALT results (IU/L), median (min–max)	1426.5 (12–18,871)
Max total bilirubin results (mg/dL), median (min–max)	1.4 (0.19–28.3)
Max direct bilirubin results (mg/dL), median (min–max)	0.5 (0.1–18.49)
Max INR results, median (min–max)	1.43 (0.95–21.67)
Max creatinine results (mg/dL), median (min–max)	1.13 (0.33–7.8)

Abbreviations: AST, aspartate aminotransferase; ALT, alanine transaminase; INR, international normalized ratio; min, minimum; max, maximum.

Table 4 The mortalities based on the mode of treatment for the patients

Mode of treatment (total cases treated)	Number of deaths (%)
Supportive therapy only (15 cases)	3 (20%)
The treatment regimen
MDAC in the regimen (27 cases)	5 (18.5%)
NAC in the regimen (35 cases)	12 (34.3%)
Pen G in the regimen (18 cases)	4 (22.2%)
Oral silymarin in the regimen (8 cases)	1 (12.5%)
Single therapy
NAC alone (7 cases)	4 (57.1%)
Oral silymarin alone (1 case)	0 (0%)
MDAC alone (1 case)	0 (0%)
Double therapy
MDAC + NAC (7 cases)	3 (42.9%)
MDAC + Pen G (2 cases)	0
NAC + Pen G (3 cases)	3 (100%)
Oral silymarin + NAC (2 cases)	0
Triple and quadruple therapy
MDAC + NAC + Pen G (12 cases)	1 (8.3%)
Oral silymarin + MDAC + NAC (4 cases)	1 (25%)
Oral silymarin + MDAC + NAC + Pen G (1 case)	0

Abbreviations: MDAC, multiple-dose activated charcoal; NAC, N-acetylcysteine intravenous; Pen G, penicillin G; Oral silymarin, oral high dose silymarin.

Table 5 The statistically significant differences of the clinical characteristics and the laboratory findings between the fatality and the survival group for every patient and for only the patients who developed hepatitis

Clinical characteristics	All patients			Patients with hepatitis
	Patients who survived (40)	Patients who died (15)	p value	Patients who survived (23)	Patients who died (14)	p value
AKI (%)	11/39 (28.2%)	14/15 (93.3%)	<0.001	10/23 (43.5%)	13/14 (92.9%)	0.003
Jaundice (%)	9/34 (26.5%)	12/13 (92.3%)	<0.001	7/22 (31.8%)	12/13 (92.3%)	0.001
Coagulopathy (%)	6/23 (26.1%)	13/13 (100%)	<0.001	5/14 (35.7%)	13/13 (100%)	0.001
Initial AST results (IU/L), median (min–max)	42.5 (18–5,500)	2,350 (44–12,592)	<0.001	61 (21–5,500)	3,137 (289–12,592)	<0.001
Initial ALT results (IU/L), median (min–max)	44.5 (12–6,268)	1,787 (23–18,871)	<0.001	68 (13–6,268)	2,100 (200–18,871)	<0.001
Max AST results (IU/L), median (min–max)	323 (18–12,300)	5,750 (2,641–12,592)	<0.001	532 (135–12,300)	5,750 (2,641–12,592)	<0.001
Max ALT results (IU/L), median (min–max)	451 (12–9,899)	3,436.5 (1,684–18,871)	<0.001	607 (76–9,899)	3436.5 (1,684–18,871)	<0.001
Max total bilirubin results (mg/dL), median (min–max)	1.2 (0.19–17.9)	6.56 (0.5–28.3)	0.011	1.34 (0.23–17.9)	6.56 (0.5–28.3)	0.004
Max direct bilirubin results (mg/dL), median (min–max)	0.4 (0.1–12.75)	3.2 (0.2–18.49)	<0.001	0.5 (0.1–12.75)	3.2 (0.2–18.49)	0.001
Max creatinine results (mg/dL), median (min–max)	0.9 (0.33–3.9)	3.5 (0.4–7.8)	<0.001	0.9 (0.33–3.9)	3.5 (0.4–7.8)	<0.001

Abbreviations: AST, aspartate aminotransferase; ALT, alanine transaminase; AKI, acute kidney disord ; min, minimum; max, maximum.