Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes

Serum creatinine in predicting mortality after paraquat poisoning: A systematic review and meta-analysis

Although the prognostic value of blood creatinine levels in patients with paraquat (PQ) poisoning has been studied for a long time, the results are still controversial. Therefore, we performed the first meta-analysis to comprehensively assess the value of blood creatinine in predicting the prognosis of patients with PQ poisoning. We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Online Journals to identify all relevant papers published up to June 2022. Data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis. Ultimately, 10 studies involving 862 patients were included. The I2 of diagnostic odds ratio (DOR), sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this study were all greater than 50%, which showed the existence of heterogeneity in this study, and a random effects model was used for the combination of the above five effect sizes. Pooled analysis showed a high predictive value of blood creatinine for prognosis of PQ poisoning [pooled DOR:22.92, 95% confidence interval (CI):15.62-33.65, P < 0.001]. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 86% (95% CI: 0.79-0.91), 78% (95% CI: 0.69-0.86), 4.01 (95% CI: 2.81-5.71), and 0.17 (95% CI: 0.12-0.25), respectively. Deeks publication bias test revealed there was publication bias. Sensitivity analysis showed no significant differences in the estimates of impact. Serum creatinine is an effective predictor of mortality in patients with PQ poisoning.

Prediction of mortality and morbidity following paraquat poisoning based on trend of liver and kidney injury

Background

Paraquat is a non-selective herbicide that causes severe tissue damage in various organs including the liver and kidney. The aim of this study was to determine the trend of the liver and kidney injury in patients with paraquat poisoning.

Methods

This retrospective cross-sectional study was performed at the Khorshid Hospital referral poisoning emergency center. The medical records of all patients with acute paraquat poisoning admitted from March 2017 to October 2020 were reviewed. Demographic factors, liver and kidney function tests and outcomes were recorded. Patients were divided into two groups based on the outcome of mortality (death or survived). The two groups were compared in terms of changes in creatinine and liver enzymes during hospitalization.

Results

A significant difference in mean creatinine levels between the two groups was observed from the third day after admission. The peak median Cr was 3.5 mg/dl for deceased patients in day 6 and 1.47 mg/dl for survived patients on 4th day. Minor elevations of ALT and AST were present in those who died. Logistic regression analysis shows patients who had level of creatinine higher than normal from the 2nd to 6th day post overdose, the risk of mortality was 4.83 to 7.44 times more than patients with normal creatinine level. The mean (SD) area under the curve for outcome prediction was reported to be excellent for creatinine on the 8th day post overdose (85.7 ± 13.2). Creatinine was higher than 2 on the 8th day post ingestion and had a sensitivity 100% and specificity 85.7% for mortality prediction (P value, 0.05).

Conclusions

The risk of mortality secondary to paraquat ingestion was highly associated with a rise in creatinine. Minor elevations of ALT and AST were also present in those who died. The creatinine concentration on different days post overdose can be helpful in predicting the severity of poisoning especially when the serum paraquat levels are not available.

Características sociodemográficas y clínicas relacionadas con la condición final de pacientes intoxicados por paraquat en un hospital del suroccidente de Colombia

Introducción.

El herbicida paraquat constituye la primera causa de decesos por intoxicaciones en distintos países.

Objetivo.

Relacionar las características sociodemográficas y clínicas con la condición final de pacientes intoxicados por paraquat atendidos en un hospital del suroccidente de Colombia.

Materiales y métodos.

En este estudio observacional, descriptivo, analítico, transversal y retrospectivo, se revisaron las historias clínicas de pacientes atendidos por intoxicación con paraquat en una institución de tercer nivel de complejidad en Pasto (Colombia) entre el 2013 y el 2018. Se recolectó la información sobre la condición final (vivo o fallecido) de cada paciente, así como los datos sociodemográficos, clínicos y de los exámenes paraclínicos. Se establecieron comparaciones por grupos y se diseñó un modelo de regresión logística binaria.

Resultados.

Se filtró la información de 299 registros y se analizaron finalmente 160 casos. Las características relacionadas con la condición final de los pacientes fueron el tiempo de estancia (OR=0,124; IC_95% 0,03-0,6; p=0,009), la frecuencia cardiaca (OR=35,65; IC_95% 1,44-884,78; p=0,029) y la creatinina inicial (OR=1,73; IC_95% 1,23-2,44; p=0,002).

Conclusiones.

La proporción de la letalidad fue mayor entre los pacientes con estancia hospitalaria corta, taquicardia y elevación de la concentración sérica de creatinina al ingreso. Este reporte puede ser útil como fundamento de una escala de gravedad para detectar a los pacientes con resultados adversos en la fase temprana para que puedan recibir una intervención oportuna.

Alveolar-arterial partial pressure difference as an early predictor for patients with acute paraquat poisoning

Objective

Paraquat (PQ) is associated with high mortality rates in acute poisoning. This study aimed to determine the importance of the alveolar–arterial partial pressure difference (A-aDo₂) in the expected consequences of acute PQ poisoning.

Methods

Patients who were hospitalized for PQ poisoning in 2018 were enrolled in this retrospective study. A-aDo₂ data were collected. Multivariate analysis was performed using binary logistic regression to determine whether A-aDo₂ is an independent risk factor for mortality from PQ.

Results

A total of 352 cases were analyzed. The mean PQ dose was 36.84 ± 50.30 mL (0.3–500 mL). There were 185 survivors and 167 non-survivors. The mean A-aDo₂ was not significantly correlated between survivors and non-survivors on day 1. However, there were significant differences in A-aDo₂ between survivors and non-survivors on days 3, 7, 14, and 21. Increased A-aDo₂ values were correlated with an increased mortality rate. The mean A-aDo₂ on day 14 showed the most significant difference between survivors and non-survivors.

Conclusion

Our study suggests that A-aDo₂ plays an important role as a reference index, which could be a useful predictor in assessing acute PQ poisoning, especially on the 14th day after onset of poisoning.