Survival predictors in paraquat intoxification and role of immunosuppression

Abstract

Paraquat poisoning resulted in multiorgan failure and is associated with high mortality. We audited 83 historical cases of paraquat poisoning in past 2 years treated with conventional decontamination and supportive treatment, followed by enrolling 85 patients over a 2 year period into additional immunosuppression with intravenous (i.v.) methylprednisolone and i.v. cyclophosphamide.Our results showed that age, poor renal function and leucocytosis are the main predictors of fatal outcome. Immunosuppression regime rendered higher survival (6 out of 17 patients (35.3%)) versus historical control (1 out of 18 patients (5.6%)) (p = 0.041) in the cohort with admission eGFR < 50 ml/min/1.73 m2 and WBC count > 11,000/μL.In contrast, there was no difference in survival with immunosuppression regime (38 out of 64 patients (59.4%)) compared to historical control (30 out of 52 patients (57.7%)) (p = 0.885) in those with eGFR > 50 ml/min/1.73 m2 or WBC < 11,000/μL at presentation.Multivariable logistic regression showed survival probability = exp(logit)/(1 + exp(logit)), in which logit = 13.962 − (0.233 × ln(age (year))) − (1.344 × ln(creatinine (μmol/L))) − (1.602 × ln(rise in creatinine (μmol/day))) – (0.614 × ln(WBC (,000/μL))) + (2.021 × immunosuppression) and immunosuppression = 1 if given and 0 if not. Immunosuppression therapy yielded odds ratio of 0.132 (95% confidential interval: 0.029–0.603, p = 0.009).In conclusion, immunosuppression therapy with intravenous methylprednisolone and cyclophosphamide may counteract immune mediated inflammation after paraquat poisoning and improve survival of patients with admission eGFR < 50 ml/min/1.73 m2 and WBC count > 11,000/μL.

Prevention of Lung Complications following Paraquat Poisoning by Silymarin, N-acetyl Cysteine and Hydrocortisone: An Experimental Study

“…Further, prevention of the inflammatory response and immune suppression has potential benefits in paraquat poisoning [2]. Hsin-Liang and coworkers confirmed that the presence of systemic inflammatory response was significantly associated with early mortality in paraquat poisoning [6].…”

“…This herbicide is one of the most common and active chemicals used in the Iranian agriculture [1]. Paraquat poisoning results in such multi-organ failures as pulmonary fibrosis, acute renal failure, and hepatic impairment, and is associated with high mortality [2]. Toxicological properties of paraquat are attributed to its ability to produce Reactive Oxygen Species (ROS), such as superoxide anion, which may directly or indirectly Use your device to scan and read the article online cause cell death [3].…”

Thoracic radiographic features of fatal paraquat intoxication in eleven dogs

“…Anti-inflammatory treatment with repeated pulse therapy of cyclophosphamide and methylprednisolone was reported to reduce the mortality rate in humans with severe paraquat poisoning [38]. More recently, intravenous cyclophosphamide and methylprednisolone were reported to be potential agents for improving patient survival [39]. Moreover, a methylprednisolone and dexamethasone combination has been used successfully in human clinical cases of paraquat intoxication [40].…”

“…More recently, intravenous cyclophosphamide and methylprednisolone were reported to be potential agents for improving patient survival (Koh et al. 2014 ). Moreover, a methylprednisolone and dexamethasone combination has been used successfully in human clinical cases of paraquat intoxication (Chen et al.…”

Survival Time and Histological Outcome of Major Organs Following Honey Administration to Acute Paraquat-Intoxicated Rats: A Preliminary Study

“…The conventional approach in treating PQ poisoning focuses on three main areas, which include the prevention of absorption from the gastrointestinal tract, the enhancement of elimination of PQ from the body and the administration of therapies directed against toxicity. Nevertheless, these treatment methods have been disappointing, with very high mortality rates [1,[6][7][8][9]. Many studies have been conducted in an effort to search for an effective antidote for PQ poisoning with several being directed towards the use of antioxidants because PQ induces its toxic effect via oxidative stress-mediated mechanisms [10][11][12][13][14].…”