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

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.

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

“…In a study by Suji Kim et al (2009), serum creatinine levels above 1.2 μg/dl were associated with increased mortality [ 12 ]. In another study conducted by Yi-soo et al (2020), serum creatinine was one of the predicting factors for clinical outcome in patients with paraquat poisoning [ 13 ].…”

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

“…A large mouthful of PQ ingested was estimated to be 60 mL for men and 40 mL for women. 6 The time lag after PQ ingestion refers to the time taken for patients to be treated in the hospital after being exposed to PQ.…”

“…The typical cause of death from PQ poisoning is pulmonary fibrosis with multiple organ failure. 6 Most PQ victims, including those who have ingested only a small amount, also gradually die, and those who swallow large doses usually only live for 72 hours. PQ causes oxidative stress, leading to systemic inflammatory response syndrome, which may cause multiorgan failure and eventually death.…”

Survival rate after paraquat poisoning: impact of emergency clinical and laboratory variables

“…Assim, com base na toxicocinética, os tratamentos mais utilizados são os adsorventes gástricos, a filtração extracorpórea e diferentes classes de medicamentos como antioxidantes, anti-inflamatórios e imunossupressores (3) . O monitoramento de sintomas clínicos e marcadores bioquímicos, também são comumente avaliados para determinar a resposta e a necessidade de tratamentos mais agressivos para pacientes com intoxicação grave por paraquat (6)(7)(8) . No entanto, os tratamentos usados e a sobrevida dos pacientes variam significativamente entre os estudos e, portanto, a eficácia da maioria desses métodos terapêuticos permanece incerta (2,(7)(8) .…”

“…O monitoramento de sintomas clínicos e marcadores bioquímicos, também são comumente avaliados para determinar a resposta e a necessidade de tratamentos mais agressivos para pacientes com intoxicação grave por paraquat (6)(7)(8) . No entanto, os tratamentos usados e a sobrevida dos pacientes variam significativamente entre os estudos e, portanto, a eficácia da maioria desses métodos terapêuticos permanece incerta (2,(7)(8) .…”