Development of a practical prediction scoring system for severe acute organophosphate poisoning

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 × 10 9 /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. K E Y W O R D Sacute organophosphate poisoning, public health, risk prediction, rural areas, scoring system

Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients – a latent class growth analysis

“…These findings suggest that routine clinical parameters, if observed repeatedly, might be useful clinical tools to identify high-risk groups of patients who might experience considerably high mortality. The mortality in our study is comparable to previously published papers on OP poisoning from different regions, including neighbouring countries [4,9,18,27,[40][41][42]; however, our study appeared to show higher (13.4%) mortality compared to a published paper (4.11%) [42] from another tertiary care setting in our metropolitan city. Although the average ages of patients in their study and our study were comparable, a significantly higher percentage of women (73%) was enrolled in the previously published study [42] than in our study (52.5%).…”

“…Commonly used scoring systems heavily depend on clinical and laboratory investigational information [4,[20][21][22][23][24][25][26] Furthermore, most scoring systems rely on single measurements, usually at the time of patient admission. The LCGA used in this study is a person-centred approach in which latent classes identify trajectories of patients based on repeated measures of very routine clinical parameters [54] .…”

“…A systematic review including data from 102 countries showed that the proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low-and middle-income countries in the European region to 48.3% in low-and middle-income countries in the Western Pacific region [3]. In neighbouring countries, the prevalence of OP poisoning among other types of poisoning varies from 7.7 to 20.7% (20.7% in China [4], 7.7% in Iran [5], and 20.7% in India [6]). Among OP poisoning cases, the case fatality rate varies from 10 to 30% in developing countries [7,8].…”

“…Many scoring systems are currently being used to evaluate the severity of acute OP poisoning, such as the Acute Physiology and Chronic Health Evaluation (APAC HE) II score [20,21], GCS, Peradeniya Organophosphorus Poisoning Scale (POPS) [22], Poisoning Severity Score (PSS) [23,24], Sequential Organ Failure Assessment (SOFA) [25], Simplified Acute Physiology Score II (SAPS II) [26], and Practical Predicting Scoring System [4]. These scoring systems are complex and rely on subjective assessment of clinical information and laboratory investigations, which are difficult to acquire or accurately describe.…”

Correlation and prognostic significance of serum amylase, serum lipase, and plasma cholinesterase in acute organophosphorus poisoning

“…revealed a rise in serum amylase in acute OP poisoning with significant P value. [ 20 ] In this study, mean amylase level was highest in to Group III and showed significant negative correlation with plasma cholinesterase levels.…”