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Park SY, Kim MJ, Park I, Kim HY, Lee M, Park YS, Chung SP. Predisposing Factors and Neurologic Outcomes of Patients with Elevated Serum Amylase and/or Lipase after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11051426. [PMID: 35268517 PMCID: PMC8910840 DOI: 10.3390/jcm11051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
This study investigated the patient outcomes, incidence, and predisposing factors of elevated pancreatic enzyme levels after OHCA. We conducted a retrospective cohort study of patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Elevation of pancreatic enzyme levels was defined as serum amylase or lipase levels that were at least three times the upper limit of normal. The factors associated with elevated pancreatic enzyme levels and their association with neurologic outcomes and mortality 28 days after OHCA were analyzed. Among the 355 patients, 166 (46.8%) patients developed elevated pancreatic enzyme levels. In the multivariable analysis (odds ratio, 95% confidence interval), initial shockable rhythm (0.62, 0.39−0.98, p = 0.04), time from collapse to return of spontaneous circulation (1.02, 1.01−1.04, p < 0.001), and history of coronary artery disease (1.7, 1.01−2.87, p = 0.046) were associated with elevated pancreatic enzyme levels. After adjusting for confounding factors, elevated pancreatic enzyme levels were associated with neurologic outcomes (5.44, 3.35−8.83, p < 0.001) and mortality (3.74, 2.39−5.86, p < 0.001). Increased pancreatic enzyme levels are common in patients treated with TTM after OHCA and are associated with unfavorable neurologic outcomes and mortality at 28 days after OHCA.
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Affiliation(s)
- Shin Young Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.Y.K.); (M.L.)
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.Y.K.); (M.L.)
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
- Correspondence: ; Tel.: +82-2-2228-2460; Fax: +82-2-2227-7908
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
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Gao Y, Hou L, Wang Y, Zhang Y, Zhang S, Li Y, Jiang Y, Zhu C, Sun T, Duan G, Yuan D. Comparison of Pancreatic Damage in Rats for Two Methods of Paraquat Administration. Front Pharmacol 2021; 12:611433. [PMID: 33967752 PMCID: PMC8099104 DOI: 10.3389/fphar.2021.611433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 01/09/2023] Open
Abstract
It is noted that elevated serum amylase levels suggesting pancreatic damage has an association with prognosis in PQ patients. This study aimed to determine whether PQ can cause pancreatic damage. The two conventional models (intragastric infusion (iG) and intraperitoneal injection (iP)) may exhibit different effects on the pancreas depending on whether or not they pass through the digestive tract. In this study, the rats were divided into four groups: the intragastric infusion group (PQ-iG, n = 45), intraperitoneal injection group (PQ-iP, n = 53), normal control group 1 (NC-iG, n = 6) and normal control group 2 (NC-iP, n = 6). Pancreatic damage was compared between groups using serum amylase activity assay, hematoxylin and eosin (H&E) staining, TUNEL assay, and transmission electron microscopy (TEM). Serum amylase levels in group PQ-iG were significantly higher than in group PQ-iP (p < 0.05). Examination of the H&E sections showed damage to the pancreas. Both experimental groups were displayed inflammatory infiltration within 9 h of PQ treatment. After 9 h, patchy necrosis was observed in group PQ-iP, when inflammatory infiltration was still the dominant pathology. Necrosis appeared and gradually worsened in group PQ-iG, in which necrosis was the dominant pathology. The TUNEL assay showed significantly higher numbers of apoptotic cells in the pancreas of PQ-groups than in the control NC- groups (p < 0.05). TEM showed expansive endoplasmic reticulum lumens and mitochondria swelling in the pancreas of the PQ-groups. It is concluded that both methods of modeling could cause pancreatic damage and the type and degree of damage would change over time. Note that pancreatic damage in group PQ-iG was more severe than that in group PQ-iP. Therefore, clinical practitioners should pay close attention to pancreatic damage caused by PQ, especially when the route of PQ administration was oral.
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Affiliation(s)
- Yanxia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Hou
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yibo Wang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shoutao Zhang
- Henan Key Laboratory of Bioactive Macromolecules, School of Life Sciences, Zhengzhou, China
| | - Yi Li
- Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yanan Jiang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Changju Zhu
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tongwen Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoyu Duan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ding Yuan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Su Y, Liu W, Dong G, Qian Z, Gurram N, Liu E, Cummings-Vaughn LA, Howard SW, Vaughn MG, Jansson DR, Zhang C, Wang J, Liu Y. Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes. Toxicol Ind Health 2020; 36:417-426. [PMID: 32787739 DOI: 10.1177/0748233720933522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Initial symptoms of paraquat (PQ) toxicity are often not obvious, and the lack of advanced testing equipment and medical conditions in the primary hospital make it difficult to provide early diagnosis and timely treatment. To explore simple, objective, and effective indicators of prognosis for primary clinicians, we retrospectively analyzed acute PQ poisoning in 190 patients admitted to our hospital from 2008 to 2017. Based on their condition at the time of discharge, patients were categorized into either the survival group (n = 71) or the mortality group (n = 119). Age, PQ ingested amount, urinary PQ, urinary protein, white blood cell (WBC), and serum creatinine (Cr) were the key factors associated with the prognosis for PQ poisoning. We identified specific diagnostic thresholds for these key indicators of PQ poisoning: PQ ingested amount (36.50 mL), urinary PQ (semiquantitative result "++"), urinary protein (semiquantitative result "±"), WBC (16.50 × 109/L), and serum Cr (102.10 µmol/L). Combining these five indicators to identify poisoning outcomes was considered objective, accurate, and convenient. When the combined score was <1, the predicted probability of patient death was 6%. When the combined score was ≥3, the predicted probability of patient death was 96%. These findings provide metrics to assist primary clinicians in predicting outcomes of acute PQ poisoning at earlier stages, a basis for administering treatment.
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Affiliation(s)
- Yiwei Su
- Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China
| | - Weiwei Liu
- Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China
| | - Guanghui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, 40272Saint Louis University, St. Louis, MO, USA
| | - Namratha Gurram
- Department of Epidemiology and Biostatistics, School of Public Health, 1084University at Albany, State University of New York, Albany, NY, USA
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, 40272Saint Louis University, Saint Louis, MO, USA
| | | | - Steven W Howard
- Department of Health Management and Policy, College for Public Health and Social Justice, 40272Saint Louis University, Saint Louis, MO, USA
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, 40272Saint Louis University, Tegeler Hall, St. Louis, MO, USA
| | - Daire R Jansson
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, 40272Saint Louis University, St. Louis, MO, USA
| | - Chen Zhang
- Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China
| | - Jianyu Wang
- Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China
| | - Yimin Liu
- Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China
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Huang C, Bai L, Xue X, Peng L, Jiang J, Zhang X. Hyperamylasemia as an early predictor of mortality in patients with acute paraquat poisoning. J Int Med Res 2020; 48:300060520910037. [PMID: 32223576 PMCID: PMC7133085 DOI: 10.1177/0300060520910037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to evaluate the relationship between elevated serum amylase levels and the prognosis of paraquat poisoning. Methods Patients were categorized into the elevated and non-elevated serum amylase groups according to serum amylase levels. Demographics, mortality, risk factors of elevated serum amylase levels, and injury to the pancreas were analyzed. Results A total of 457 patients were enrolled in this study and the overall mortality rate was 51.9%. Patients in the elevated group had worse indices than those in the non-elevated group. Kaplan–Meier survival analysis showed that the mortality rate in the elevated group was significantly higher than that in the non-elevated group (hazard ratio: 10.65, 95% confidence interval [CI]: 7.55–15.02). Multivariate Cox proportional hazards analysis showed that elevated serum amylase levels were related to mortality (hazard ratio: 2.066, 95% CI: 1.239–3.444). The receiver operating characteristic curve showed that the area under the curve was 0.724 (95% CI: 0.666–0.783) for serum amylase levels with 70.4% sensitivity and 74.0% specificity. Conclusion Elevated serum amylase levels are observed in PQ poisoning. This elevation might be one of the most accurate early prognostic factors for predicting severity and mortality.
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Affiliation(s)
- Changbao Huang
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Lina Bai
- Department of Emergency Medicine, the 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiang Xue
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Liangfei Peng
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Jinghan Jiang
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Xigang Zhang
- Department of Emergency Medicine, the 5th Medical Center of Chinese PLA General Hospital, Beijing, China
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Sequential organ failure assessment in predicting mortality after paraquat poisoning: A meta-analysis. PLoS One 2018; 13:e0207725. [PMID: 30444919 PMCID: PMC6239328 DOI: 10.1371/journal.pone.0207725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022] Open
Abstract
Sequential organ failure assessment (SOFA) score is commonly used to determine disease severity and predict prognosis in critically ill patients. However, the prognostic value of SOFA after acute paraquat (PQ) poisoning remains unclear. This meta-analysis aimed to study the capability of SOFA to predict mortality in patients with PQ poisoning. Databases that included PubMed, Embase, Web of Science, ScienceDirect, Embase, and Cochrane Library were searched through May 2018. Six studies involving 946 patients were included in the meta-analysis. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and then ORs with 95% CIs were pooled for the estimation of the prognostic role of SOFA in patients with PQ poisoning. Results showed that higher SOFA in patients with PQ poisoning was related to severe mortality (OR = 8.14, 95%CI 4.26–15.58, p<0.001). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR, and area under the curve were 72% (95%CI 0.65–0.79), 75% (95%CI 0.65–0.83), 2.9 (95%CI 2.0–4.1), 0.37 (95%CI 0.28–0.41), 8 (95%CI 4–14), and 0.79 (95%CI 0.76–0.83), respectively. No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Sensitivity analyses showed no important differences in the estimates of effects. The high SOFA score (8.1-fold) was associated with severe mortality in patients with PQ poisoning.
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A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning. PLoS One 2018; 13:e0201200. [PMID: 30044873 PMCID: PMC6059481 DOI: 10.1371/journal.pone.0201200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/10/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is the identification of a reliable predictor of prognosis to optimize the treatment of acute paraquat (PQ) poisoning patients. We performed a retrospective analysis on 96 patients with acute PQ poisoning to evaluate leucocyte count as a predictor of 90-day survival. These patients were admitted to the emergency department from May 2012 to February 2017. Kaplan–Meier method was used to compare the 90-day survival. Cox proportional hazard models were utilized to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of leucocyte with respect to 90-day survival. Result showed that leucocyte was significantly higher among nonsurvivors than that among survivors (p<0.001). Leukocyte was also an independent predictor of survival according to the multivariate Cox analysis (HR 1.103; 95%CI: 1.062–1.146; p<0.001). The area under the curve (AUC) for leucocyte (AUC 0.911; 95%CI: 0.855–0.966; p<0.001) showed a discriminatory potential similar to that of the plasma PQ concentration (AUC 0.961; 95%CI: 0.926–0.997; p<0.001) in predicting 90-day survival. The leucocyte count is a strong predictor of survival in patients with acute PQ poisoning.
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Wei TY, Yen TH, Cheng CM. Point-of-care testing in the early diagnosis of acute pesticide intoxication: The example of paraquat. BIOMICROFLUIDICS 2018; 12:011501. [PMID: 29430271 PMCID: PMC5775096 DOI: 10.1063/1.5003848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/04/2018] [Indexed: 05/09/2023]
Abstract
Acute pesticide intoxication is a common method of suicide globally. This article reviews current diagnostic methods and makes suggestions for future development. In the case of paraquat intoxication, it is characterized by multi-organ failure, causing substantial mortality and morbidity. Early diagnosis may save the life of a paraquat intoxication patient. Conventional paraquat intoxication diagnostic methods, such as symptom review and urine sodium dithionite assay, are time-consuming and impractical in resource-scarce areas where most intoxication cases occur. Several experimental and clinical studies have shown the potential of portable Surface Enhanced Raman Scattering (SERS), paper-based devices, and machine learning for paraquat intoxication diagnosis. Portable SERS and new SERS substrates maintain the sensitivity of SERS while being less costly and more convenient than conventional SERS. Paper-based devices provide the advantages of price and portability. Machine learning algorithms can be implemented as a mobile phone application and facilitate diagnosis in resource-limited areas. Although these methods have not yet met all features of an ideal diagnostic method, the combination and development of these methods offer much promise.
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Affiliation(s)
- Ting-Yen Wei
- Interdisciplinary Program of Life Science, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and Chang Gung University, Linkou 333, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan
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