The clinical features of acute kidney injury in patients with acute paraquat intoxication

Abstract

Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO 2 (P = 0.006) and higher alveolar-arterial O 2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO 2 at admission (P = 0.031), higher PaO 2 at admission (P = 0.015), lower nadir PaCO 2 (P = 0.001) and lower nadir HCO 3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO 2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO 2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.

Efficacy and safety of pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide in patients with paraquat poisoning: A meta-analysis

“…ARF or hypoxia occurred frequently in patients with PQ poisoning, and patients who suffered from ARF or hypoxia had worse outcome [12,17]. Previous study did not show a reduced incidence of ARF and hypoxia with the pulse immunosuppressive therapy [9].…”

Prediction of early mortality in patients with paraquat intoxication

“…Acute kidney injury occurred in more than half of patients with paraquat intoxication in one previous study. 18 The extent of renal function impairment and hypokalemia in paraquat intoxication are strongly associated with early mortality. Therefore, for emergency physicians, we recommend that aggressive treatments might be helpful for salvageable patients (who initially present with the signs of survival for longer than 72 hours).…”

Kidney damage biomarkers detect acute kidney injury but only functional markers predict mortality after paraquat ingestion

“…Deliberate self-poisoning with paraquat herbicide is common and has an estimated case fatality of more than 50% 56 (Dawson et al, 2010), particularly when followed by acute kidney injury (AKI) (Kim et al, 2009; Lee et al, 2002). 57…”