Changes in the concentrations of creatinine, cystatin C and NGAL in patients with acute paraquat self-poisoning

Abstract

An increase in creatinine >3 μmol/L/h has been suggested to predict death in patients with paraquat self-poisoning and the value of other plasma biomarkers of acute kidney injury has not been assessed. The aim of this study was to validate the predictive value of serial creatinine concentrations and to study the utility of cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) as predictors of outcome in patients with acute paraquat poisoning. The rate of change of creatinine (dCr/dt) and cystatin C (dCyC/dt) concentrations were compared between survivors and deaths. Receiver-operating characteristic (ROC) curves were constructed to determine the best threshold for predicting death. Paraquat was detected in 20 patients and 7 of these died between 18 h and 20 days post-ingestion. The dCr/dt ROC curve had an area of 0.93 and the cut-off was >4.3 μmol/L/h (sensitivity 100%, specificity 85%, likelihood ratio 7). The dCyC/dt ROC curve had an area of 0.97 and the cutoff was >0.009 mg/L/h (sensitivity 100%, specificity 91%, likelihood ratio 11). NGAL did not separate survivors from deaths. Death due to acute paraquat poisoning is associated with changes in creatinine and cystatin concentrations. Further validation of these measurements is needed before they can be adopted in guiding intensive treatments.

The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer

“…as a surrogate marker of organ damage particularly AKI in patients consuming poisonous substances remains to be explored further [263]. The observation that Lcn2 is strongly induced in BMSCs induced to undergo osteoblastic differentiation suggests a possible role of Lcn2 in stem cell differentiation and possibly a therapeutic role as a target in stem cell based tissue engineering [111].…”

Simple and sensitive liquid chromatography–tandem mass spectrometry methods for quantification of paraquat in plasma and urine: Application to experimental and clinical toxicological studies

“…Acute renal failure is the first systemic symptom observed in PQ toxicity although the main cause of death from PQ toxicity is severe pulmonary damage [2,[4][5][6][7]. Mortality rate from accidental or intentional paraquat ingestion has been reported to be high especially in Asia [8][9][10]. An analytical method for plasma and urine is essential for toxicokinetic studies of this herbicide.…”

Serum creatinine and cystatin C provide conflicting evidence of acute kidney injury following acute ingestion of potassium permanganate and oxalic acid

“…Creatine, creatol and methylguanidine act as a homeostatic antioxidant to reduce circulating free radicals [49]. Generation of free radicals leads to extra production of sCr [50,51] to meet the higher energy demand under oxidative stress as noted following several paraquat poisoning [3]. Therefore we propose that the observed rapid and large rise of sCr is contributed by increased production and conversion of creatine to creatinine.…”