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Sepahi S, Gerayli S, Delirrad M, Taghavizadeh Yazdi ME, Zare-Zardini H, Bushehri B, Ghorani-Azam A. Biochemical responses as early and reliable biomarkers of organophosphate and carbamate pesticides intoxication: A systematic literature review. J Biochem Mol Toxicol 2023; 37:e23285. [PMID: 36524544 DOI: 10.1002/jbt.23285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/03/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Inhibition of cholinesterase (ChE) activity has been long considered as the main diagnostic method of organophosphate (OP) and carbamate pesticides poisoning; however, it has been shown that ChE activity may also be altered due to exposure to other non-organophosphorus toxicants and variety of different medical conditions. Hence, to avoid misdiagnosis, we aimed to systematically review available documents to look for additional biomarkers of OP and carbamate poisoning. The electronic databases in addition to Google scholar were searched for eligible articles on March 2022 using "organophosphate," "carbamate," and "biomarker" including all their similar terms. After collecting the relevant documents, the data were extracted and described qualitatively. In total, data of 66 articles from 51 human and 15 animal studies were extracted. Findings demonstrated that enzymes such as β-glucuronidase, neuropathy target esterase, amylase, and lipase, in addition to hematological indicators such as CBC, CRP, lactate dehydrogenase, and CPK have high sensitivity and accuracy in the diagnosis of OP poisoning. Findings suggest that using various markers for diagnosis of OP intoxication is helpful for appropriate management, and early identifying the patients at risk of death. The suggested biomarkers also help to avoid misdiagnosis of OP poisoning with other similar conditions.
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Affiliation(s)
- Samaneh Sepahi
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Sina Gerayli
- Division of Inflammation and inflammatory Diseases, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Delirrad
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Hadi Zare-Zardini
- Hematology and Oncology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Sciences, Farhangian University, Isfahan, Iran
| | - Behzad Bushehri
- Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | - Adel Ghorani-Azam
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
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Hosseini SM, Rahimi M, Afrash MR, Ziaeefar P, Yousefzadeh P, Pashapour S, Evini PET, Mostafazadeh B, Shadnia S. Prediction of acute organophosphate poisoning severity using machine learning techniques. Toxicology 2023; 486:153431. [PMID: 36682461 DOI: 10.1016/j.tox.2023.153431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023]
Abstract
Poisoning with organophosphate compounds is a significant public health risk, especially in developing countries. Considering the importance of early and accurate prediction of organophosphate poisoning prognosis, the aim of this study was to develop a machine learning-based prediction model to predict the severity of organophosphate poisoning. The data of patients with organophosphate poisoning were retrospectively extracted and split into training and test sets in a ratio of 70:30. The feature selection was done by least absolute shrinkage and selection operator method. Selected features were fed into five machine learning techniques, including Histogram Boosting Gradient, eXtreme Gradient Boosting, K-Nearest Neighborhood, Support Vector Machine (SVM) (kernel = linear), and Random Forest. The Scikit-learn library in Python programming language was used to implement the models. Finally, the performance of developed models was measured using ten-fold cross-validation methods and some evaluation criteria with 95 % confidence intervals. A total of 1237 patients were used to train and test the machine learning models. According to the criteria determining severe organophosphate poisoning, 732 patients were assigned to group 1 (patients with mild to moderate poisoning) and 505 patients were assigned to group 2 (patients with severe poisoning). With an AUC value of 0.907 (95 % CI 0.89-0.92), the model developed using XGBoost outperformed other models. Feature importance evaluation found that venous blood gas-pH, white blood cells, and plasma cholinesterase activity were the top three variables that contribute the most to the prediction performance of the prognosis in patients with organophosphate poisoning. XGBoost model yield an accuracy of 90.1 % (95 % CI 0.891-0.918), specificity of 91.4 % (95 % CI 0.90-0.92), a sensitivity of 89.5 % (95 % CI 0.87-0.91), F-measure of 91.2 % (95 % CI 0.90-0.921), and Kappa statistic of 91.2 % (95 % CI 0.90-0.92). The machine learning-based prediction models can accurately predict the severity of organophosphate poisoning. Based on feature selection techniques, the most important predictors of organophosphate poisoning were VBG-pH, white blood cell count, plasma cholinesterase activity, VBG-BE, and age. The best algorithm with the highest predictive performance was the XGBoost classifier.
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Affiliation(s)
- Sayed Masoud Hosseini
- Toxicological Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Rahimi
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Afrash
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Pashapour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Peyman Erfan Talab Evini
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Mostafazadeh
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Nejatifar F, Abdollahi M, Attarchi M, Roushan ZA, Deilami AE, Joshan M, Rahattalab F, Faraji N, Kojidi HM. Evaluation of hematological indices among insecticides factory workers. Heliyon 2022; 8:e09040. [PMID: 35299610 PMCID: PMC8920855 DOI: 10.1016/j.heliyon.2022.e09040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022] Open
Abstract
Insecticides are commonly used pesticides in the world. Chronic exposure to insecticides has adverse effects on various human body organs. In this study, hematological findings were assessed in workers in an insecticide manufacturing plant. Hematological parameters and clinical symptoms were recorded in 99 workers exposed to insecticides and 107 workers not exposed to them in a cross-sectional study. Assessment of the hematological results showed a higher prevalence of thrombocytosis in the exposed group than the non-exposed group (P < 0.05). Mean white blood cell (WBC) and platelet counts, anisocytosis of red blood cells (RBCs), and neutrophils to lymphocytes ratio (NLR) were significantly higher in the exposed group compared to the non-exposed group (P < 0.05). Prevalence rates of headache, itchy skin, cough, and sleep disorders were higher in the exposed group than in the non-exposed group (P < 0.05). Chronic exposure to insecticides can alter hematological parameters in the normal range. Occupational exposure to insecticides may increase WBCs, platelet count, NLR, and red cell distribution width (RDW). It can also cause thrombocytosis. Complete blood count (CBC), as an inexpensive and accessible tool, can help monitor workers' health status exposed to insecticides properly.
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Affiliation(s)
- Fatemeh Nejatifar
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Abdollahi
- School of Pharmacy and Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mirsaeed Attarchi
- Inflammatory Lung Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Biostatistics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Etemadi Deilami
- Department of Occupational Health, Rasht Health Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Joshan
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Rahattalab
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Faraji
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Mohammadi Kojidi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Tang Y, Chen H, Qiu W, Zhou Y, Hong G, Hu L, Zhao G, Chen X, Zhi S, Lu Z. Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients. Ther Drug Monit 2021; 43:797-806. [PMID: 34780392 DOI: 10.1097/ftd.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paraquat ( PQ) is very poisonous to humans and animals and there is no effective clinical antidote . The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies. METHODS The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by high-performance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed. RESULTS Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50-1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was <516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was <516 ng/mL in the death group was only 19%. CONCLUSIONS The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.
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Affiliation(s)
- Yahui Tang
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Hui Chen
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Weiyong Qiu
- Department of Intensive Care Medicine, Yiwu Hospital Affiliated to Wenzhou Medical University
| | - Yanxue Zhou
- Department of Nephrology, Yiwu Hospital Affiliated to Wenzhou Medical University, Yiwu; and
| | - Guangliang Hong
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Lufeng Hu
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guangju Zhao
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Xiaorong Chen
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Shaoce Zhi
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Zhongqiu Lu
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
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5
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Dong N, Wang S, Li X, Li W, Gao N, Pang L, Xing J. Prognostic nomogram for the severity of acute organophosphate insecticide self-poisoning: a retrospective observational cohort study. BMJ Open 2021; 11:e042765. [PMID: 34031108 PMCID: PMC8149305 DOI: 10.1136/bmjopen-2020-042765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop a convenient nomogram for the bedside evaluation of patients with acute organophosphorus poisoning (AOPP). DESIGN This was a retrospective study. SETTING Two independent hospitals in northern China, the First Hospital of Jilin University and the Lequn Hospital of the First Hospital of Jilin University. PARTICIPANTS A total of 1657 consecutive patients admitted for the deliberate oral intake of AOPP within 24 hours from exposure and aged >18 years were enrolled between 1 January 2013 and 31 December 2018. The exclusion criteria were: normal range of plasma cholinesterase, exposure to any other type of poisonous drug(s), severe chronic comorbidities including symptomatic heart failure (New York Heart Association III or IV) or any other kidney, liver and pulmonary diseases. Eight hundred and thirty-four patients were included. PRIMARY OUTCOME MEASURE The existence of severely poisoned cases, defined as patients with any of the following complications: cardiac arrest, respiratory failure requiring ventilator support, hypotension or in-hospital death. RESULTS 440 patients from one hospital were included in the study to develop a nomogram of severe AOPP, whereas 394 patients from the other hospital were used for the validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with age, white cells, albumin, cholinesterase, blood pH and lactic acid levels. The AUC was 0.875 (95% CI 0.837 to 0.913) and 0.855 (95% CI 0.81 to 0.9) in the derivation and validation cohorts, respectively. The calibration plot for the probability of severe AOPP showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. CONCLUSION A convenient severity evaluation nomogram for patients with AOPP was developed, which could be used by physicians in making clinical decisions and predicting patients' prognosis.
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Affiliation(s)
- Ning Dong
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Shaokun Wang
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Xingliang Li
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Wei Li
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Nan Gao
- Third Clinical Hospital of Changchun Traditional Chinese Medicine University, Changchun, Jilin, China
| | - Li Pang
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Jihong Xing
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
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6
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Clinical profile and outcome of acute organophosphate poisoning in children of Upper Egypt: a cross-sectional study. BMC Pediatr 2021; 21:98. [PMID: 33637060 PMCID: PMC7908781 DOI: 10.1186/s12887-021-02563-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Organophosphates are one of the most common agents of poisoning in developing countries including Egypt. Due to lack of data about characteristics of organophosphates poisoning in our localities, we aimed to evaluate its clinical pattern and factors affecting outcome. Methods It was a cross-sectional study conducted in South valley University hospital between January 2019 and December 2019. It included all children ≤16 years of age presented with organophosphates poisoning. Diagnosis was performed from the history taken from the patient’s relatives and presenting symptoms. Demographic data, mode and route of poisoning, time from exposure to presentation, clinical symptomatology, grading and routine investigations were evaluated in addition to treatment taken and outcome. Results During the study period, 108 children; mean age was 7.95 ± 4.11 years (range 1. 5-16 years) presented with organophosphorous poisoning. Sixty five (60%) cases were females and 43 (40%) were males. Unintentional acts (87%) were detected more than suicidal (13%) and inhalation route (63.8%) more than ingestion (36. 2%). Miosis was the most frequent clinical sign (100%) followed by respiratory distress (77.7%). Regarding time of presentation to emergency department, 43 (40%) cases were presented within 6 h while others presented more than 6 h post-exposure. Mechanical ventilation (MV) was needed for 14 (13%) cases and 6 (5.5%) cases died due to respiratory failure. Duration of hospital stay, mean time interval from toxic exposure to hospital presentation, leucocytosis, need for MV and cumulative dose of pralidoxime were significantly higher in non survivors than survivors while Pao2 (partial arterial oxygen) and GCS (Glasgow coma scale) were significantly lower. Conclusion This study concluded that time consumed till presentation to hospital, low GCS, need for MV, leucocytosis, decreased PaO2 and increased cumulative dose of pralidoxime were independent risk factors of mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02563-w.
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Dong N, Lu ZX, Li XL, Li W, Pang L, Xing JH. Clinical correlates of hypotension in patients with acute organophosphorus poisoning. World J Emerg Med 2021; 12:24-28. [PMID: 33505546 DOI: 10.5847/wjem.j.1920-8642.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning (AOPP). METHODS In this retrospective cohort study, we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals. Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension. We also evaluated the association between clinical parameters (including hypotension) and in-hospital mortality. RESULTS The incidence of hypotension in AOPP patients was 16.4%. Hypotensive patients showed significantly higher in-hospital mortality (1.1% vs. 39.9%, P<0.001). Advanced age (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.08-1.44), history of diabetes (OR 2.65, 95% CI 1.14-5.96), and increased white blood cell count (OR 1.06, 95% CI 1.03-1.09), plasma cholinesterase (OR 0.91, 95% CI 0.84-0.94), plasma albumin (OR 0.88, 95% CI 0.85-0.92), serum amylase (OR 1.01, 95% CI 1.01-1.02), and blood pH (OR 0.64, 95% CI 0.54-0.75) were significantly associated with hypotension. After adjusting for potential confounders, hypotension was associated with increased in-hospital mortality (hazard ratio 8.77-37.06, depending on the controlled variables). CONCLUSIONS Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality. Advanced age, history of diabetes, and changes in laboratory parameters were associated with hypotension in AOPP patients.
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Affiliation(s)
- Ning Dong
- Department of Emergency, the First Hospital of Jilin University, Changchun 130021, China
| | - Zhe-Xi Lu
- School of Medicine, Pennsylvania State College of Medicine, Hershey 17033, USA
| | - Xing-Liang Li
- Department of Emergency, the First Hospital of Jilin University, Changchun 130021, China
| | - Wei Li
- Department of Emergency, the First Hospital of Jilin University, Changchun 130021, China
| | - Li Pang
- Department of Emergency, the First Hospital of Jilin University, Changchun 130021, China
| | - Ji-Hong Xing
- Department of Emergency, the First Hospital of Jilin University, Changchun 130021, China
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Wu M, Zhou C, Li M, Yu H, Zhao D, Xue W, Qin L, Peng A. Depletion of NK cells attenuates paraquat-induced acute lung injury by manipulating macrophage polarization. Int Immunopharmacol 2020; 86:106698. [PMID: 32559567 DOI: 10.1016/j.intimp.2020.106698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/16/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Acute lung injury is the main causative factor in paraquat dichloride (PQ)-induced mortality. The innate immune system-triggered detrimental inflammatory cascade plays a vital role in PQ-induced acute lung injury. However, the role of natural killer (NK) cells, which are essential for innate response, in PQ-induced acute lung injury remains largely unknown. Here, we found that in an acute PQ poisoning model, depletion of NK cells attenuated PQ-induced lung injury by inhibiting macrophage polarization towards the M1 type. Specifically, the percentages of NK cells were reduced in the lung, spleen, and peripheral blood in a murine model of acute PQ poisoning. NK cells were aberrantly activated, evidenced by upregulation of the activating markers CD69, CD107a, and NKG2D and downregulation of the inhibitive marker KLRG1. Further, NK-specific depletion in mice greatly prolonged the survival time and ameliorated reactive oxygen species-induced damage following PQ treatment compared with the control group. Importantly, NK cell depletion alleviated macrophage and neutrophil infiltration in the lung and reversed PQ induced-macrophage polarization towards the pro-inflammatory M1 type. Our study demonstrates a crucial role of NK cells and NK cell-to-macrophage interaction in PQ-induced acute lung injury.
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Affiliation(s)
- Mingyu Wu
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Chunyu Zhou
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Mengyuan Li
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Haibo Yu
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Dake Zhao
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Wen Xue
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China
| | - Ling Qin
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China.
| | - Ai Peng
- Center for Nephrology & Metabolomics, Division of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China.
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Dong N, Liu J, Wang Z, Gao N, Pang L, Xing J. Development of a practical prediction scoring system for severe acute organophosphate poisoning. J Appl Toxicol 2020; 40:889-896. [PMID: 32030807 DOI: 10.1002/jat.3950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 11/07/2022]
Abstract
Acute organophosphorus poisoning (AOPP) is a serious public health issue, especially in the rural areas. This study was designed to establish a scoring system to assess the risk of cases with severe AOPP. A retrospective cohort study was conducted at two independent hospitals. The derivation cohort included 444 patients with AOPP and the validation cohort included 274 patients. A risk score for patients with severe AOPP was developed. The rates of severe AOPP cases were 20.7% and 20.1% in the derivation and validation cohorts, respectively. A scoring system for severe AOPP risk was developed that included: (1) age >50 years, (2) white blood cell count of >15 × 109 /L, (3) plasma cholinesterase of <360 U/L, (4) plasma albumin of <35 g/L, (5) blood pH <7.3, and (6) lactic acid >3.0 mmol/L. The predicted score in severe cases of AOPP had good accuracy in both the derivation (area under the receiver operating characteristic curve [AUC] 0.88, 95% confidence interval [CI], 0.85-0.92) and validation cohorts (AUC 0.83, 95% CI, 0.77-0.90). A practical bedside prediction scoring system was developed for patients with severe AOPP. The routine use of this scoring system could rapidly assist in identifying patients at higher risk who require more intensive care or transfer to a larger better-equipped hospital.
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Affiliation(s)
- Ning Dong
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Junlan Liu
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Zhihao Wang
- Department of Geriatrics, the Fist Hospital of Jilin University, Changchun, China
| | - Nan Gao
- Department of Emergency, the Third Clinical Hospital of Changchun Traditional Chinese Medicine University, Changchun, China
| | - Li Pang
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Jihong Xing
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
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10
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Gao Y, Guo S, Wang Y, Yu S, Wang M, Lu X, Li Y. Lymphocyte and its CD4+ and CD8+ subgroup changes after paraquat poisoning. Hum Exp Toxicol 2019; 38:1024-1030. [PMID: 31104516 DOI: 10.1177/0960327119851252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Paraquat (PQ) poisoning is a significant cause of mortality and morbidity in developing countries. Poor prognostic outcomes have been attributed to the herbicide's toxicity and the lack of effective treatments. Our study aims to investigate the changes in lymphocyte count in both patients who survived and died from PQ poisoning and explore the prognostic value. METHOD This is a retrospective case serials observational study. Adult patients admitted with acute PQ poisoning. The notes of 1000 patients who presented with acute PQ poisoning were reviewed. One hundred thirty patients having the T lymphocyte met the inclusion criteria and were grouped into those that survived the poisoning (95) and non-survivors (35). RESULTS On admission, non-survivors had a higher ingestion volume of PQ and urine PQ concentration as well as higher severity indices (Acute Physiology and Chronic Health Evaluation 2, Sequential Organ Failure Assessment, and Poisoning Severity Score). Patients in the survival group had a higher dosage of immunosuppressant and a longer hospital stay. Leukocytes, especially neutrophils, were higher among non-survivors; however, the converse was found with lymphocytes. T lymphocyte (CD3) count was consistently higher among survivors as well as the subgroups CD4+ and CD8+. No differences in the ratio of CD4/CD8 were found between the groups. CONCLUSION Our study has shown that changes in lymphocyte count as its subgroups could indicate a host's immune status and lymphocytes play an important role as a surrogate marker of host immunity, which could be a useful prognostic tool in the assessment of this disease.
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Affiliation(s)
- Y Gao
- 1 Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - S Guo
- 2 Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Y Wang
- 1 Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - S Yu
- 3 Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - M Wang
- 4 Hospital Affairs Office, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - X Lu
- 3 Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Y Li
- 3 Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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