الفهرس 
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Abstract
Poisoning with OP compounds is responsible for great morbidities and mortalities all over the world especially in developing countries including Egypt. br The highly variable history and difficulty in determining the dose and specific OP compound ingested make predicting outcome for an individual person inaccurate and potentially hazardous. Patients admitted in good condition can deteriorate rapidly and may require intubation and mechanical ventilation. br Scoring systems have been continuously developed to predict outcomes in patients with severe illness, to improve resource allocation and to assist in clinical decision-making particularly for intensive care unit (ICU) patients. Acute physiology and -#99;-#104;-#114;onic health evaluation II (APACHE II) is a representative system currently in wide use for measuring the condition of individual ICU patients. Moreover, the Sequential Organ Failure Assessment (SOFA) score has been validated in the critical care setting against a number of different conditions, and has been shown to have a good correlation between predicted and observed patient outcomes. br OP poisoning is associated with various biochemical abnormalities among which hyperamylasemia is well documented. Serum amylase could be considered as a better predictor of severity followed by lipase. br This work aimed to study the role of the some indices that may help in the assessment of the severity and outcome of acutely organophosphorus intoxicated cases. These indices include; APACHE II score, SOFA score serum amylase and lipase. br This work presented a retrospective and prospective study carried out at Poison Control Center Ain Shams University (PCCA). The study included two hundreds acutely organophosphorus intoxicated patients. They were selec-#116;ed according to predetermined criteria. br For every patient, the following data was studied: br - Sociodemographic variables (age, sex, residence and occupation) br - Clinical data (history, physical finding on admission) br - APACHE II and SOFA scores were calculated to each patient admitted br - Laboratory data: br Biochemical analysis of pseudocholinestrease enzyme, serum amylase and lipase enzymes were estimated. br - Other laboratory investigational data were recorded for patients, included random blood glucose, Serum potassium, Arterial blood pH and ECG changes. br - Treatment and hospital admission br - Outcome br - Complications br The results were tabulated and statistically analyzed and revealed the following: br The mean value age of the patients in the study was 23.4 years. Most of patients were belonging to teenager and middle age -#103;-#114;-#111;-#117;-#112; (18 – 40 years) representing 44.5% of the patients in the study. Females affected more than males with a female to male ratio1.1: 1. and patients -#102;-#114;-#111;-#109; urban areas were more than rural areas. br Acute organophosphate intoxication was found commonly occurring in unemployed (43%) followed by students (23%) and lastly housewives (12%). br There was no significant difference between discharged and died patients as regards age and residence. But there was significant relation between sex and mortality. The majority of died patients (70%) were males. br Attempting suicide was the main etiology of these cases in present study, followed by accidental intake. Majority of patients (96.5%) consumed the poison through oral route. The mean value of the delay time was 4.84 hours and in the majority of cases (84.5%), delay time was less than 6 hours. br There was no significant difference as regard mode of poisoning, route of intake and delay time in discharged and died patients. br As regard blood pressure; 93% of patients in the present study had normal blood pressure, while 2% had hypertension and 5% presented with hypotension. 89% of patients had normal heart rate and 9.5% had tachycardia. 2.5% of patients presented with tachypnea, 3.5% of patients presented with bradypnea and the remaining patients had normal respiratory rate. Most of patients (92%) had normal temperature and 8% of patients had fever. Shock observed in 2.5% of patients. br The mean GCS of patients was 12.98. There were 89% of patients had GCS -gt; 8, while 11% of patients had GCS ≤8. br There was significant relation between the outcome and blood pressure, shock development, heart rate and respiratory rate, -#119;-#104;-#101;-#114;-#101; hypotension and shock observed more in died patients than discharged, and also bradycardia and bradypnea was more in died than discharged while tachycardia was more in discharged patients. br Vomiting was the most frequent symptom (82.5%) followed by pupil constriction observed in 71% of patients and diarrhea occurred in 36.5% of patients. br The mean APACHE II score of patients was 6.37. The APACHE II score ranged between 0 and 38. There were 76% of patients had APACHE II score ≤ 9, while 12.5% of patients had APACHE II score -#102;-#114;-#111;-#109; 10 to 14, there were 8.5% of patients had APACHE II score -#102;-#114;-#111;-#109; 15 to 24 and APACHE II score was -gt; 24 in 3% of patients. br The mean SOFA score of patients was 2.34. The SOFA score ranged between 0 and 15. SOFA score in 88.5%of patients was ≤ 6, while in 4.5% of patients SOFA score was -#102;-#114;-#111;-#109; 7 to 9 and in 7%of patients SOFA score was -gt; 9. br There was significant difference between discharged and died patients as regards APACHE II and SOFA Scores -#119;-#104;-#101;-#114;-#101; patients who died had high APACHE II and SOFA Scores than discharged patients. br There was no significant difference as regard psudocholinestrease, between the discharged and died patients. br There was significant difference between discharged and died patients as regards serum amylase and lipase, -#119;-#104;-#101;-#114;-#101; hyperamylasemia observed in 83.3% of died. 33.3% of died patients had increased lipase. br There was no significant difference between discharged and died cases as regard random blood glucose and serum potassium level br There was significant difference between discharged and died patients as regards blood pH, -#119;-#104;-#101;-#114;-#101; 90% of died and developed acidosis. br There was significant association between development of prolonged QTc, premature ventricular contraction, ventricular tachycardia, Sinus bradycardia, Ischemia and Complete heart block as well as the outcome -#119;-#104;-#101;-#114;-#101; these changes were more among died than discharged patients. br There were 57.5% of patients admitted to inpatient unit and 42.5% of them were admitted to ICU. The mean of hospital admission duration was 2.35 days. br As regard antidotes received; 42.5% of patients received atropine only, 57.5% received atropine and toxogonin The mean of total atropine dose needed by the patients in the study was 22.98 (mg) and the mean of total toxogonin dose was 0.81 (gm). br In the present study there was significant relation between increased duration of hospital admission, total atropine and toxogonin doses for the patients and increase of mortality. br There was 15.5% of patients needed mechanical ventilation. There was significant association with need for mechanical ventilation and the outcome -#119;-#104;-#101;-#114;-#101; most of died patients had been needed mechanical ventilation while, most of discharged patients didn’t need mechanical ventilation. br The outcome of patients in the present study was as follow, 180 patients were discharged representing about 90% and 20 patients were died representing about 10%. The overall mortality rate in this study was 10%. br Twenty four percent of the patients in the present study developed complications. The respiratory failure was the commonest of these complications affecting 16.5% of patients followed by coma in 12%. br It was found that there was significant relation between death and development of arrhythmia, shock, respiratory failure, pneumonia, coma, convulsion and pancreatitis. br In the present study there was significant positive correlation between APACHE II score and SOFA score with the hospital admission duration, total atropine and toxogonin doses received. Serum amylase was positively correlated with the hospital stay duration, total atropine dose and toxogonin doses. There was significant positive correlation between lipase and hospital stay duration and total toxogonin dose, but no correlation with total atropine dose. br In the present study there was significant association between severity of OP poisoning and APACHEII score, SOFA score, serum amylase and lipase levels. br APACHEII, SOFA scores and serum amylase could be used as predictors of outcome of acutely organophosphorus intoxicated patients, while lipase couldn’t be used in outcome prediction. br So all can predict the outcome of organophosphorus poisoning but SOFA score had the highest accuracy and predictive ability followed by APACHE II score while serum amylase was the least one. br Finally SOFA score could be considered as a better predictor of outcome of acutely organophosphorus intoxicated patients followed by APACHE II score and serum amylase.