Factors influencing prognosis in patients with suspected Amatoxin poisoning.

BACKGROUND: Amatoxin poisoning is associated with high mortality, and hepatic injury markers are well-established prognostic indicators. However, predictors reflecting extrahepatic organ dysfunction remain inadequately characterized. This study aimed to identify independent risk factors for mortality beyond conventional liver function parameters in patients with suspected amatoxin poisoning, thereby enhancing early risk stratification and guiding clinical management. METHODS: We retrospectively reviewed patients treated for suspected amatoxin poisoning at our Hospital from 2013 to 2022. Patients were categorized into non-survivor and survivor groups based on in-hospital outcomes. Demographic, clinical, and laboratory data were extracted from medical records. Multivariable logistic regression analysis was conducted to determine independent predictors of mortality. RESULTS: A total of 108 patients were included, 76 survived, and 32 died. The median age was 44 years (IQR: 36.00-53.50 years) for survivors and 50 years (IQR: 42.25-60.00 years) for non-survivors. Non-survivors were older (P = 0.035), had higher levels of bilirubin, transaminases, creatinine, lactate, and CK-MB, and a lower proportion of patients with preserved consciousness (all P < 0.05). Multivariable analysis identified elevated CK-MB (OR = 1.01, 95% CI 1.00-1.03, P = 0.045) and altered consciousness (preserved consciousness vs. altered consciousness, OR = 0.14, 95% CI 0.02-0.69, P = 0.016) as independent mortality predictors. CONCLUSION: Elevated CK-MB levels and impaired consciousness are independent risk factors for mortality in suspected amatoxin poisoning and may reflect critical extrahepatic involvement.