{"id":3468,"date":"2022-03-30T10:00:13","date_gmt":"2022-03-30T07:00:13","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3468"},"modified":"2022-04-12T17:53:31","modified_gmt":"2022-04-12T14:53:31","slug":"zehirlenme_mortalite_skorlamasi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2022\/03\/30\/zehirlenme_mortalite_skorlamasi\/","title":{"rendered":"Yeni \u00d6nerilen Bir Prediksiyon Arac\u0131: Zehirlenmelerde Mortalite Skorlamas\u0131"},"content":{"rendered":"

Akut zehirlenmeler d\u00fcnya \u00e7ap\u0131nda \u00f6nemli bir sa\u011fl\u0131k sorunudur. Kaza ile veya bilin\u00e7li olarak toksik maddelere maruz kal\u0131nmas\u0131 sonucunda mortalite riskinin hesaplanmas\u0131 ve hastan\u0131n ona g\u00f6re y\u00f6netilmesi istenilen bir t\u0131bbi yakla\u015f\u0131md\u0131r. Ancak toksikoloji biliminde zehirlenmelerin ciddiyetini de\u011ferlendirmek ve k\u0131yaslamak i\u00e7in hen\u00fcz genel kabul g\u00f6rm\u00fc\u015f zehirlenme ciddiyeti skoru yoktur. PSS (poisoning severity score<\/em>) baz\u0131 spesifik zehirlenmelerde kullan\u0131lsa da nadiren anlaml\u0131 kullan\u0131m\u0131 olmaktad\u0131r. Kritik bak\u0131mda klinik skorlama sistemleri \u00e7e\u015fitli zehirlenme vakalar\u0131nda uygulanmaktad\u0131r. Bunlar\u0131n ba\u015f\u0131nda \u201cThe Acute Physiology and Chronic Health Evaluation<\/em>\u201d (APACHE) skoru\u00a0 ve\u00a0 \u201cSimplified Acute Physiology<\/em>\u201d\u00a0 (SAPS) skoru gelir. Zehirlenme vakalar\u0131nda mortalite hastalar\u0131n altta yatan fizyolojik durumlar\u0131na ve zehirin kendine has karakteristiklerine ba\u011fl\u0131d\u0131r. Al\u0131nan maddenin tipi, al\u0131m yolu,\u00a0 al\u0131m miktar\u0131, al\u0131m nedeni sonu\u00e7lar\u0131 etkiler. Al\u0131nan maddelerin ne oldu\u011fu \u00e7o\u011funlukla tespit edilemez ve maddenin lethal dozu da bilinmedi\u011fi i\u00e7in hasta ciddiyeti ancak semptom ve klinikteki bulgular ile tespit edilebilir. \u0130deal bir mortalite \u00f6ng\u00f6rd\u00fcrme skoru ayn\u0131 zamanda hastan\u0131n fizyolojik durumunu hesaba katmal\u0131d\u0131r ve genel ya\u015f guruplar\u0131nda uygulanabilmelidir. Maddenin mortalite \u00fczerindeki direkt etkisini g\u00f6stermek \u00fczere geli\u015ftirilmi\u015f olan \u201cPoisoning Mortality Score\u201d (PMS), bug\u00fcn tan\u0131taca\u011f\u0131m ve \u00fcmit vaat edici bir skor olarak g\u00f6z\u00fckmekte.<\/p>\n

Kore\u2019 de Han ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan ve size okuman\u0131z\u0131 \u00f6nerdi\u011fim yeni bir \u00e7al\u0131\u015fma mevcut. Kore \u00dcniversitesi taraf\u0131ndan modere edilen, Critical Care dergisinde 2021 y\u0131l\u0131nda yay\u0131nlanan\u00a0 \u00e7al\u0131\u015fmada \u201cKorea Center for Disease Control and Prevention (KCDC)\u201d veri taban\u0131nda 2011-2018 aras\u0131nda toplanan zehirlenme hastalar\u0131 incelenmi\u015ftir. Hastalar\u0131n ya\u015f, cinsiyet, acile ba\u015fvuru zaman\u0131, maruziyet s\u00fcresi, zehirlenmedeki hastan\u0131n maksad\u0131, al\u0131m yolu, maddenin tipi, vital bulgular, mental durum, acilde veya yat\u0131\u015f s\u0131ras\u0131ndaki mortaliteler analiz edilmi\u015ftir. PMS geli\u015ftirmek i\u00e7in se\u00e7ilen 42.568 ki\u015fiden olu\u015fan \u00e7al\u0131\u015fma populasyonu iki gruba b\u00f6l\u00fcnm\u00fc\u015f; birinci grup hastane i\u00e7i mortalite \u00f6ng\u00f6rme i\u00e7in derivasyon grubu ve di\u011fer grup ise prediksiyon modeli i\u00e7in eksternal validasyon grubu. Hasta se\u00e7imini g\u00f6steren bir ak\u0131\u015f \u015femas\u0131 \u015eekil-1\u2019de mevcuttur.<\/p>\n

\"\"

Hasta Se\u00e7imi. KCDC: Korea Center for Disease Control and Prevention<\/em><\/p><\/div>\n

Primer sonlan\u0131m olarak hastane i\u00e7i mortalite kabul edilmi\u015f. Toplam 1044 mortalite g\u00f6r\u00fclm\u00fc\u015f. Analizde zehirlenmenin karakteristik \u00f6zellikleri olan\u00a0 hastan\u0131n al\u0131m nedenleri; istemeden al\u0131m, maksatl\u0131 al\u0131m veya bilinmeyen olarak \u00fc\u00e7e b\u00f6l\u00fcnm\u00fc\u015f. Al\u0131m yollar\u0131; dermal, ok\u00fcler, oral, inhalasyon olarak s\u0131n\u0131fland\u0131r\u0131lm\u0131\u015f. Toplamda 44 \u00e7e\u015fit toksik madde sekiz ayr\u0131 kategoride s\u0131n\u0131fland\u0131r\u0131lm\u0131\u015f. Maddeler mortalite indeksine (MI) g\u00f6re ayn\u0131 s\u0131n\u0131flara konulmu\u015f. MI de\u011feri, toksine ba\u011fl\u0131 \u00f6l\u00fcm say\u0131s\u0131 toplam toksine maruziyet vakas\u0131na b\u00f6l\u00fcm\u00fcne g\u00f6re hesaplanm\u0131\u015f. \u00d6rne\u011fin, MI de\u011ferlerine g\u00f6re en az toksik olan A kategorisinde\u00a0 MI de\u011feri % 0,5\u2019ten az olan toksinler yer al\u0131rken, en toksik\u00a0 olan parakuat %52,5 ile F kategorisinde yer alm\u0131\u015f. A\u2019dan H\u2019ye kadar olan bu kategori listesinde H grubunda do\u011fal toksik ajanlar var ve bu grupta MI %1 de\u011ferinin alt\u0131nda.<\/p>\n

Toksik ajanlar\u0131n mortalite indekslerine g\u00f6re da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de mevcuttur.<\/p>\n

Tablo 1 Derivasyon grubunda madde s\u0131n\u0131f\u0131na ve \u00f6l\u00fcm indeksine g\u00f6re maruz kal\u0131nan maddeler kategorilendirili\u015fi<\/strong><\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Kategori<\/td>\nMadde<\/td>\n<\/tr>\n
A<\/td>\n(1) Hormonlar, hormon antegonistleri, kontraseptifler<\/td>\n(2) Diagnostik reaktifler<\/td>\n(3) Vitamin ve diyet takviyeleri<\/td>\n<\/tr>\n
<\/td>\n(4) Topikal ajanlar<\/td>\n(5) Asetaminofen<\/td>\n(6) Antipsikotikler<\/td>\n<\/tr>\n
<\/td>\n(7) Antidepresanlar<\/td>\n(8) Zolpidern<\/td>\n(9) Doksilamin<\/td>\n<\/tr>\n
<\/td>\n(10) Tan\u0131mlanmam\u0131\u015f sedatifler, antipsikotikler, hipnotikler<\/td>\n(11)Benzodiazepinler<\/td>\n<\/td>\n<\/tr>\n
B<\/td>\n(1) Gastrointestinal ila\u00e7lar<\/td>\n(2) Antihistaminikler<\/td>\n(3) So\u011fuk ve \u00f6ks\u00fcr\u00fck ila\u00e7lar\u0131<\/td>\n<\/tr>\n
<\/td>\n(4) Tan\u0131mlanmam\u0131\u015f terapotik ila\u00e7lar<\/td>\n(5) Antikonv\u00fclsanlar<\/td>\n(6) Kardiyovask\u00fcler ila\u00e7lar<\/td>\n<\/tr>\n
<\/td>\n(7) Tan\u0131mlanmam\u0131\u015f a\u011fr\u0131 kesiciler<\/td>\n(8) Antibiyotikler, antifungaller<\/td>\n(9) Opioidler<\/td>\n<\/tr>\n
<\/td>\n(10) Stim\u00fclanlar<\/td>\n(11) Ast\u0131m ila\u00e7lar\u0131<\/td>\n(12) Oral hipoglisemik ila\u00e7lar<\/td>\n<\/tr>\n
C<\/td>\n(1) Alkol (lik\u00f6r, etanol, metanol)<\/td>\n(2) A\u011f\u0131r metaller<\/td>\n(3) Hidrokarbonlar<\/td>\n<\/tr>\n
D<\/td>\n(1)Tan\u0131mlanmam\u0131\u015f yapay toksik maddeler<\/td>\n(2) Tan\u0131mlanmam\u0131\u015f alkaliler<\/td>\n(3) Tan\u0131mlanmam\u0131\u015f asitler<\/td>\n<\/tr>\n
<\/td>\n(4) Tan\u0131mlanmam\u0131\u015f korozif ajanlar<\/td>\n(5) Rodentisid<\/td>\n(6) Tan\u0131mlanmam\u0131\u015f b\u00f6cek ila\u00e7lar\u0131<\/td>\n<\/tr>\n
<\/td>\n(7) Piretroid<\/td>\n(8) Tan\u0131mlanmam\u0131\u015f pestisitler<\/td>\n(9) Tan\u0131mlanmam\u0131\u015f herbisitler<\/td>\n<\/tr>\n
<\/td>\n(10) Glifosat<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
E<\/td>\n(1) Glacial asetik asit<\/td>\n(2) Organofosfatlar<\/td>\n(3) Karbanatlar<\/td>\n<\/tr>\n
F<\/td>\n(1) Paraquat<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
G<\/td>\n(1) Karbonmonoksit<\/td>\n(2) Tan\u0131mlanmam\u0131\u015f gazlar<\/td>\n<\/td>\n<\/tr>\n
H<\/td>\n(1) Do\u011fal toksik maddeler<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

Hastalar\u0131n demografik \u00f6zellikleri, zehirlenme ile ili\u015fkili \u00f6zellikler, toksik maddenin kategorisi, vital bulgular, AVPU\u2019 ya g\u00f6re, mental duruma g\u00f6re puanlamalar yap\u0131lm\u0131\u015f. Bu yeni geli\u015ftirilmi\u015f Zehirlenme Mortalite skoruna g\u00f6re haz\u0131rlanm\u0131\u015f tablo \u015f\u00f6yle;<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
YA\u015e<\/strong><\/td>\nPUAN<\/strong><\/td>\nP DE\u011eER\u0130<\/strong><\/td>\n<\/tr>\n
<40<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
40- 59<\/td>\n7<\/td>\n<0.001<\/td>\n<\/tr>\n
60-69<\/td>\n12<\/td>\n<0.001<\/td>\n<\/tr>\n
70- 74<\/td>\n16<\/td>\n<0.001<\/td>\n<\/tr>\n
75- 79<\/td>\n16<\/td>\n<0.001<\/td>\n<\/tr>\n
>80<\/td>\n19<\/td>\n<0.001<\/td>\n<\/tr>\n
C\u0130NS\u0130YET<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
KADIN<\/td>\n0<\/td>\n<\/td>\n<\/tr>\n
ERKEK<\/td>\n4<\/td>\n<0.001<\/td>\n<\/tr>\n
ALIM \u015eEKL\u0130<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u0130STEMS\u0130Z<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
MAKSATLI<\/td>\n8<\/td>\n<0.001<\/td>\n<\/tr>\n
B\u0130L\u0130NMEYEN<\/td>\n9<\/td>\n<0.001<\/td>\n<\/tr>\n
ALIM YOLU<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
DERMAL, OKULER<\/td>\n0<\/td>\n0.274<\/td>\n<\/tr>\n
ORAL<\/td>\n8<\/td>\n0.169<\/td>\n<\/tr>\n
\u0130NHALASYON<\/td>\n5<\/td>\n0.493<\/td>\n<\/tr>\n
MADDE KATEGOR\u0130S\u0130<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
A<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
B<\/td>\n11<\/td>\n<0.001<\/td>\n<\/tr>\n
C<\/td>\n15<\/td>\n<0.001<\/td>\n<\/tr>\n
D<\/td>\n21<\/td>\n<0.001<\/td>\n<\/tr>\n
E<\/td>\n27<\/td>\n<0.001<\/td>\n<\/tr>\n
F<\/td>\n47<\/td>\n<0.001<\/td>\n<\/tr>\n
G<\/td>\n15<\/td>\n<0.001<\/td>\n<\/tr>\n
H<\/td>\n12<\/td>\n<0.001<\/td>\n<\/tr>\n
S\u0130STOL\u0130K TA mmHg<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u2265100<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
70- 99<\/td>\n6<\/td>\n<0.001<\/td>\n<\/tr>\n
\u226469<\/td>\n15<\/td>\n<0.001<\/td>\n<\/tr>\n
KALP HIZI\/ dak<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
70-119<\/td>\n0<\/td>\n0.001<\/td>\n<\/tr>\n
30-69<\/td>\n1<\/td>\n0.323<\/td>\n<\/tr>\n
120-159<\/td>\n4<\/td>\n0.001<\/td>\n<\/tr>\n
\u2265160<\/td>\n8<\/td>\n0.008<\/td>\n<\/tr>\n
SOLUNUM SAYISI\/ dak<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
12-24<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
\u226411 VEYA \u226525<\/td>\n5<\/td>\n<0.001<\/td>\n<\/tr>\n
V\u00dcCUT ISISI ( \u030aC)<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<39<\/td>\n0<\/td>\n<\/td>\n<\/tr>\n
\u226539<\/td>\n6<\/td>\n0.235<\/td>\n<\/tr>\n
MENTAL DURUM<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
ALERT<\/td>\n0<\/td>\n<0.001<\/td>\n<\/tr>\n
VERBAL YANIT<\/td>\n5<\/td>\n<0.001<\/td>\n<\/tr>\n
A\u011eRIYA YANIT<\/td>\n8<\/td>\n<0.001<\/td>\n<\/tr>\n
YANITSIZ<\/td>\n16<\/td>\n<0.001<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

Yukar\u0131daki tablo ve skorlar belirlenirken \u00f6nce hastane i\u00e7inde mortalitesi olan ve sa\u011f kalan gruplar gruplar\u0131n karakteristiklerine bak\u0131lm\u0131\u015f. Hastane i\u00e7inde mortalitesi y\u00fcksek olanlar\u0131n ya\u015fl\u0131, erkek, maksatl\u0131 al\u0131m\u0131 olan, oral alan, d\u00fc\u015f\u00fck kan bas\u0131nc\u0131, y\u00fcksek kalp h\u0131z\u0131, y\u00fcksek solunum say\u0131s\u0131 olan ve mental durumu bozuk olan hastalar oldu\u011fu g\u00f6zlenmi\u015f. Madde al\u0131m\u0131 ile hastaneye geli\u015f aras\u0131nda ge\u00e7en s\u00fcrenin sa\u011f kal\u0131ma etkisi olmam\u0131\u015f (p <\/em>= 0,057).\u00a0 Tablodaki 10 predikt\u00f6r \u00fczerinden sa\u011f kalan ve kalmayanlar k\u0131yaslanm\u0131\u015f. \u00d6nce multivariable lojistik regresyon modelinde regresyon katsay\u0131s\u0131 B hesaplanm\u0131\u015f. B sabiti multivariable modelde 0,124 olarak hesapland\u0131ktan sonra her predikt\u00f6r\u00fcn puan kar\u015f\u0131l\u0131\u011f\u0131 g\u00f6sterilmi\u015f. Bu skorlama tablodaki her parametre kar\u015f\u0131l\u0131\u011f\u0131ndaki puan\u0131n toplam\u0131ndan olu\u015fmakta. Yani minimum puan 0 iken maksimum puan 137 olabilmekte. Derivasyon ve validasyon gruplar\u0131nda ger\u00e7ek aral\u0131klar ise 0-117 ve 8-115 olarak hesaplanm\u0131\u015f.<\/p>\n

 <\/p>\n

PMS s\u0131n\u0131flamas\u0131ndaki risk s\u0131n\u0131flar\u0131;<\/p>\n

    \n
  1. \n
      \n
    1. \u00c7ok d\u00fc\u015f\u00fck mortalite riski olanlar\u00a0 \u00a0 \u00a0 \u00a0 \u00a00-27 puan,<\/li>\n
    2. D\u00fc\u015f\u00fck mortalite riski olanlar\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a028-40 puan,<\/li>\n
    3. Orta mortalite riski olanlar\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 41- 55 puan,<\/li>\n
    4. Y\u00fcksek mortalite riski olanlar\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 56 puan ve yukar\u0131s\u0131.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n

      PMS s\u0131n\u0131flamas\u0131ndaki risk gruplar\u0131na g\u00f6re derivasyon ve validasyon hasta gruplar\u0131nda s\u0131ras\u0131yla g\u00f6zlenen mortaliteler;<\/p>\n

        \n
      1. \n
          \n
        1. \u00c7ok d\u00fc\u015f\u00fck mortalite riski olanlarda\u00a0 \u00a0 %0.04 ve %0<\/li>\n
        2. D\u00fc\u015f\u00fck mortalite riski olanlarda\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0%0.31 ve %0.28<\/li>\n
        3. Orta mortalite riski olanlarda\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0% 2.53 ve % 1.82<\/li>\n
        4. Y\u00fcksek mortalite riski olanlarda \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 %24.10 ve % 18.61<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n

          Kabaca s\u00f6yleyecek olursak hastalar\u0131n PMS skorlar\u0131 41 puan \u00fczerine \u00e7\u0131kt\u0131\u011f\u0131nda mortalite riski klinik olarak anlaml\u0131 ve tehditkar d\u00fczeye \u00e7\u0131kmaktad\u0131r.<\/strong><\/p>\n

          Zehirlenme hastalar\u0131nda sonlan\u0131m\u0131 \u00f6ng\u00f6rd\u00fcren skorlamalar hakk\u0131nda \u00e7al\u0131\u015fmalar \u00e7ok azd\u0131r. Yap\u0131lan \u00e7al\u0131\u015fmalar genelde yo\u011fun bak\u0131mda yatan hastalar\u0131n takipleri s\u0131ras\u0131nda kullan\u0131lan skorlamalardan olu\u015fmaktalar. Bu yeni PMS skorlamas\u0131 ise acil servise zehirlenme nedeniyle gelen hastalar\u0131n ba\u015fvuru s\u0131ras\u0131ndaki parametreleri ile hesaplanan bir skorlama sistemidir. APACHE-II, APACHE-IV, SAPS-II skorlar\u0131 ile yap\u0131lan \u00e7al\u0131\u015fmalar literat\u00fcrde mevcuttur. \u00d6zellikle APACHE-II hastalar yo\u011fun bak\u0131mda yatarken erken d\u00f6nemde mortaliteyi \u00f6ng\u00f6rd\u00fcrmek i\u00e7in faydal\u0131d\u0131r. Ancak bu skorlamadaki mortalite \u00f6l\u00fcm nedeni zehirin kendi nat\u00fcr\u00fc ile ilgili fakt\u00f6rler olup olmad\u0131\u011f\u0131n\u0131 ay\u0131rt edememektedir. Oysa ki bu yeni PMS\u00a0 zehirlenmenin \u00f6l\u00fcme neden olan iki ana katk\u0131s\u0131n\u0131 g\u00f6z \u00f6n\u00fcne almaktad\u0131r. Bu iki \u00f6zellik; zehire has \u00f6zellikler ile hastan\u0131n akut d\u00f6nemdeki fizyolojik durumudur.<\/p>\n

          Bu skorlama geli\u015ftirilirken kullan\u0131lan multivariable lojistik regresyon modeli pek \u00e7ok prognoz belirleme skorlama sisteminin geli\u015ftirilmesinde ve \u00e7al\u0131\u015fmalarda katk\u0131s\u0131 oldu\u011funu s\u00f6ylemeliyiz. Derivasyon ve validasyon gruplar\u0131nda uyumlu olacak \u015fekilde risk skoru ile \u00f6l\u00fcm olas\u0131l\u0131\u011f\u0131 aras\u0131nda direkt orant\u0131 saptanm\u0131\u015ft\u0131r. PMS kullan\u0131lmas\u0131n\u0131n d\u00fc\u015f\u00fck riskli hastalar\u0131n hastaneye yatmas\u0131n\u0131 engellemesini, acillerin i\u015f y\u00fck\u00fcn\u00fc azaltmas\u0131n\u0131 bekleyebiliriz. \u00d6te yandan y\u00fcksek risk skoru olan hastalar\u0131n ise h\u0131zl\u0131ca daha \u00fcst merkezlere y\u00f6nlendirilmesi sa\u011flanabilir.\u00a0 \u00dclkemizden uzak bir co\u011frafyada yap\u0131lan bu \u00e7al\u0131\u015fman\u0131n uygulanabilir olup olmad\u0131\u011f\u0131n\u0131 ise zaman g\u00f6sterecek.<\/p>\n

          Kaynaklar<\/strong><\/p>\n

            \n
          1. Persson H, Sj\u00f6berg G, Haines J, Pronczuk de Garbino J. Poisoning Severity Score: Grading of acute poisoning. J Toxicology – Clinical Toxicology (1998) 36:205-13.<\/li>\n
          2. Han et al, Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department. Critical Care. 2021; 25:29<\/li>\n
          3. Lionte C, Sorodoc V, Jaba E, Botezat A. Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents: an observational study. Medicine. 2017;96(12):e6404.<\/li>\n<\/ol>\n
              \n
            1. Cheung R, Hoffman RS, Vlahov D, Manini AF. Prognostic utility of initial lactate in patients with acute drug overdose: a validation cohort. Ann Emerg Med. 2018;72(1):16\u201323.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

              Akut zehirlenmeler d\u00fcnya \u00e7ap\u0131nda \u00f6nemli bir sa\u011fl\u0131k sorunudur. Kaza ile veya bilin\u00e7li olarak toksik maddelere maruz kal\u0131nmas\u0131 sonucunda mortalite riskinin hesaplanmas\u0131 ve…<\/p>\n","protected":false},"author":1538,"featured_media":3475,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10010,10014],"tags":[10030,10031,405],"class_list":["post-3468","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-slider","category-akademik-blog-yazisi","tag-mortalite","tag-skorlama","tag-toksikasyon"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3468","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1538"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3468"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3468\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3475"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3468"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3468"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3468"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}