Serum Level of Inflammatory Mediators as Prognostic Biomarkers of Severity of Caustic Injury; A Prospective Study at the Poison Control Center – Ain Shams University Hospitals.

Document Type : Original Article

Authors

1 forensic medicine and clinical toxicology department,faculty of medicine,Ain shams university,Cairo,Egypt

2 Forensic Medicine and Clinical Toxicology department, Faculty of Medicine, Ain Shams University, Cairo , Egypt

3 Fellow in poison control center, Ain Shams University Hospitals, Cairo, Egypt

4 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University

Abstract

Background: Caustic injury, caused by the ingestion of corrosive substances, is a serious health concern worldwide due to its high morbidity and mortality rate. Aim: The present study aims to investigate the possible role of serum levels of inflammatory mediators namely cortisol, C-reactive protein (CRP) and alpha 1 antitrypsin (AAT) in the detection of the severity of corrosive ingestion. Methods: This prospective study was conducted through collecting demographic, clinical data and blood samples from 30 patients with corrosive ingestion admitted to the Poison Control Centre of Ain Shams University Hospitals. Complete blood count (CBC), serum levels of inflammatory mediators were analyzed at 24 and 72 hours post ingestion. Follow up of the patients was done at the outpatient clinic for three weeks for development of strictures. Results: The studied patients were 13 females (43.3 %) and 17 males (56.7 %) whose mean age was 2.7±1.26 years. Twenty patients were admitted to the inpatient wards and ten patients were admitted to the intensive care unit (ICU). The presence of hematemesis, respiratory distress, metabolic acidosis on admission and the formation of stricture and extended hospital stay were significantly higher in the ICU group than the inpatient group. A significant higher level of CRP and AAT was detected in the ICU group, and the high levels of both mediators correlated with the prolonged duration of hospital stay. AAT level greater than 179 ng/ml at 24 hours was significantly associated with the formation of strictures. Conclusions: This study provides evidence supporting the potential role of CRP and AAT as reliable biomarkers in predicting the severity and outcome of caustic ingestion. Moreover, a cut-off value of AAT serum level of 179 ng/ml is considered for predicting the susceptibility of formation of strictures in patients with corrosive ingestion, hence directing treatment for better patient outcomes.

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