Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning

Sen, Rajdip; Nayak, Jadumani; Khadanga, Sagar

doi:10.17511/ijmrr.2014.i03.03

Cited by 24 publications

(31 citation statements)

References 13 publications

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“…This study revealed that there was nonsignificant difference between patients who developed respiratory failure and those who didn't as regard serum pseudocholinesterase level measured at 4 th day of poisoning. These results were in parallel with that of Sen et al (2014) who mentioned that Serum pseudocholinesterase serves as a diagnostic parameter for OP poisoning but it cannot be used as a prognostic biomarker.…”

Section: Discussionsupporting

confidence: 79%

“…These results supported by Sen et al (2014) who found that serum levels of LDH showed non significant difference between patients with acute OP poisoning who developed serious complications which end in death and those who showed complete clinical recovery. According to these results, they concluded that LDH is not a reliable indicator for prognosis and prediction of severe complications including respiratory failure.…”

Section: Discussionsupporting

confidence: 70%

“…In a harmony with the previous results, a study carried out by Sen et al (2014) showed that there was a statistically significant difference between survivors and non survivors from OP poisoning regarding CPK level and suggested that it can be used as a measure of prognostic significance.…”

Section: Discussionsupporting

confidence: 66%

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Role of Repetitive Nerve Stimulation, Serum Creatine Phosphokinase and Lactate Dehydrogenase in Early Prediction of Respiratory Failure in Acute Organophosphorus Poisoning

El-Nagdy

Shehta

2015

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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The most serious complication associated with acute organophosphorus (OP) poisoning is intermediate syndrome (IMS) due to the possibility of developing respiratory failure. Abnormalities observed in repetitive nerve stimulation (RNS) may help to assess severity of IMS and eventually help to predict the cases which are more liable to develop respiratory failure. Also, some researchers suggested that IMS is associated with rhabdomyolysis which is followed by a rise in creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) serum levels. The aim of this work was to study the role of RNS and serum levels of CPK and LDH in predicting respiratory failure in acute OP poisoning. The study was carried out on 55 patients who were diagnosed as acute OP poisoning and admitted at Poison Control Center, Zagazig University Hospitals in the period from April 2013 to June 2014. The patients were subjected to estimation of serum pseudocholinesterase, CPK and LDH levels at time of admission and repeated at the 4 th day of poisoning. Also, RNS test at 3 hertz (HZ) frequency was done to all patients at 2nd, 3rd and 4 th day of poisoning (the period at which IMS is expected). At the end of the study, it was found that the patients who developed respiratory failure showed significant increase in decrement response recorded by RNS and in serum CPK level. On the other hand, there was non-significant difference between patient who developed respiratory failure and those who didn't as regard serum LDH level. It was concluded from this study that, RNS test at 3 HZ and serum CPK level can be used as early predictors of respiratory failure in acute OP poisoning and it's recommended to use them especially in patients who are clinically diagnosed as severe poisoning at time of admission.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 70%

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Role of Repetitive Nerve Stimulation, Serum Creatine Phosphokinase and Lactate Dehydrogenase in Early Prediction of Respiratory Failure in Acute Organophosphorus Poisoning

El-Nagdy

Shehta

2015

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…But all these assays are dependent on specialized laboratories and costly. So cheap and easily measurable biomarkers having prognostic value is the need of the hour (Sen et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

Moussa

Mohamed

Hilal

et al. 2018

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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All right received. AbstractPoisoning with Organophosphate (OP) compounds is responsible for great morbidities and mortalities all over the world especially in developing countries including Egypt. Scoring systems have been continuously developed to predict outcomes in patients with severe illness, to improve resource allocation and to assist in clinical decision-making particularly for ICU patients. The quest for biomarkers in relation to OP compound poisoning started quite a long time back but cheap and easily measurable biomarkers having prognostic value is the need of the hour. The objective of this study is to evaluate the role of acute physiology and chronic health evaluation II (APACHE II) score, the Sequential Organ Failure Assessment (SOFA) score, serum amylase and lipase in assessing severity and outcome of acute organophosphorus poisoning. A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. APACHE II and SOFA scores were calculated to each patient admitted and biochemical analysis of serum amylase and lipase were estimated in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study showed that there were 76% of patients had APACHE II score ≤ 9, while 12.5% of patients had APACHE II score from 10 to 14, there were 8.5% of patients had APACHE II score from 15 to 24 and APACHE II score was > 24 in 3% of patients. SOFA score in 88.5%of patients was ≤ 6, while in 4.5% of patients SOFA score was from 7 to 9 and in 7%of patients SOFA score was > 9. Hyperamylasemia observed in 83.3% of died and 33.3% of died patients had increased lipase. There was significant difference between discharged and died patients as regards APACHE II score, SOFA Score, serum amylase and lipase. It could be concluded that SOFA score, APACHEII score, serum amylase and lipase had a role in assessment of severity of acute organophosphorus poisoning but only SOFA score, APACHEII score and serum amylase could be used as predictors of outcome. SOFA score is more useful in predicting mortality, and easier and simpler than the APACHEII and serum amylase. From the previous results, our study recommends that predictors of outcome (APACHE II score, SOFA score and serum amylase) should be assessed routinely and as early as possible to evaluate the severity, improve the course of management and deciding the pathway of care.

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“…Various prognostic tools such as serum creatine phosphokinase (CPK), lactate dehydrogenase (LDH), serum immunoglobulins, and circulating complements for early detection of patients at high risk for developing respiratory failure have been tried. [ 9 ] There will be the elevation of serum CPK in OP poisoning due to myonecrosis caused by persistent depolarization at the neuromuscular junction and oxidative cellular damage to muscle membrane. [ 10 11 ] Serum CPK level has also been studied as a predictor for the onset of IMS, but in earlier studies CPK has been measured only at admission and/or prior to discharge.…”

Section: Introductionmentioning

confidence: 99%

Serum creatine phosphokinase as predictor of intermediate syndrome in organophosphorus poisoning

kumar¹,

Bhuvana²,

Venkatarathnamma³

et al. 2015

Indian Journal of Critical Care Medicine

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Background:Organophosphorus (OP) compounds are commonly used pesticides. In OP poisoning, intermediate syndrome (IMS) manifests between the end of the acute cholinergic crisis and delayed neuropathy. Respiratory paralysis in IMS, if identified early can reduce the need for ventilator support, morbidity, and mortality. Serum creatine phosphokinase (CPK) is elevated in IMS. The objectives of our study were to measure serum CPK level, correlate CPK levels with severity of poisoning and estimate atropine dose used.Materials and Methods:A prospective, observational study was conducted for 1-year. Patients diagnosed with OP poisoning were included. Demographic characteristics, type of poison, time since poisoning, Peradeniya Organophosphorus Poisoning (POP) score, serum pseudocholinesterase, CPK levels, atropine dose, and outcome of treatment were documented.Results:Seventy-five patients were recruited of which 57% and 43% were males and females, respectively, with a mean age of 31.48 ± 11.76 years. The most common OP compound was chlorpyriphos followed by triazophos and methylparathion. The time required to reach hospital was 181.26 ± 89.53 min. About 73.3% and 26.7% of patients had mild and moderate poisoning, respectively, as per POP scale. Pseudocholinesterase level was 364 (205–2168) IU. The amount of atropine used was 190.66 ± 78.83 mg. Serial serum CPK values were 279.72 ± 350.21 IU, 389.78 ± 376.33 IU and 163.13 ± 155.15 IU at admission, 48 h, and 96 h after admission, respectively. A weak positive correlation between serum CPK levels and severity of poisoning (r = 0.352) was observed. All patients recovered completely within 10.69 ± 5.57 days. Three patients developed IMS, and their serial CPK levels were 1837.33 ± 243.19 IU/L, 1935 ± 97.41 IU/L, and 714.66 ± 394.82 IU/L; and recovered in 17 ± 5.6 days.Conclusion:Increased serum CPK levels at 48 h after poisoning was observed in all the patients, but three patients had more than 1500 IU/L, who manifested with IMS. Early diagnosis of IMS by serial estimation of CPK may help in timely intervention and reduce further life-threatening complications.

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Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning

Cited by 24 publications

References 13 publications

Role of Repetitive Nerve Stimulation, Serum Creatine Phosphokinase and Lactate Dehydrogenase in Early Prediction of Respiratory Failure in Acute Organophosphorus Poisoning

Role of Repetitive Nerve Stimulation, Serum Creatine Phosphokinase and Lactate Dehydrogenase in Early Prediction of Respiratory Failure in Acute Organophosphorus Poisoning

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

Serum creatine phosphokinase as predictor of intermediate syndrome in organophosphorus poisoning

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