Quantifying disease severity in amanitin-intoxicated patients by fusing common laboratory values

Frontiers in Toxicology, vol. 8

Abstract

Introduction Amanitin intoxication following ingestion of amatoxin-containing mushrooms can cause acute hepatic and renal failure. We evaluated the feasibility of using an adapted Patient Vital Status (PVS) fusion score derived from routine laboratory parameters to assess disease severity in amanitin-intoxicated patients. Methods In this retrospective single-center pilot study (2023–2024), pseudonymized laboratory data from 16 adults with urine-confirmed amanitin intoxication and 12 control patients with comparable laboratory measurements were analyzed. PVS was calculated using prothrombin time (Quick), alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and lactate dehydrogenase (LDH), with predefined normal values and an intermediate-care reference group (n = 5) for severity scaling. Results Intoxicated patients had significantly higher maximum and mean PVS values than controls (PVSmax: 0.75 ± 0.54 vs. 0.12 ± 0.04; PVSmean: 0.32 ± 0.25 vs. 0.05 ± 0.02; mean ± standard deviation; both p < 0.001). Exploratory k-means clustering (k = 4) yielded four descriptive severity groups. The most severely affected patient reached a maximum PVS of 1.91 (ALT 10,373 U/L; AST 8,776 U/L; Quick 26.7%). Among patients with a matched ingestion time, the median time to peak PVS was 3.03 days (Q1–Q3, 2.13–3.54; n = 15). PVS was positively associated with Model for End-Stage Liver Disease (MELD) scores (p < 0.001). One patient died (last PVS 1.34). Urinary amanitin concentrations were not significantly associated with severity metrics. Discussion These findings support the feasibility of adapting PVS for longitudinal laboratory-based severity assessment in amanitin intoxication. Given the exploratory nature and limited sample size of this pilot study, validation in larger prospective cohorts is warranted.

Authors 5

1. Philipp L. S. Ohland

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute for Laboratory Animal Science, Hannover Medical School

2. Stephan Halle

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute of Clinical Chemistry and Laboratory Medicine, Hannover Medical School

   Institute of Immunology, Hannover Medical School

3. Korbinian Brand

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute of Clinical Chemistry and Laboratory Medicine, Hannover Medical School

4. André Bleich

   Medizinische Hochschule Hannover

   Affiliation as printed

   Institute for Laboratory Animal Science, Hannover Medical School

5. Steven R. Talbot Aachen Institute of Medical Statistics

   RWTH Aachen University · Universitätsklinikum Aachen · Medizinische Hochschule Hannover

   Affiliation as printed

   Institute for Laboratory Animal Science, Hannover Medical School

   Institute of Medical Statistics, RWTH Aachen University Hospital