CT imaging as a prognostic indicator for patients with pulmonary injury from acute paraquat poisoning

Zhang, H; Liu, P; Qiao, Pengyan; Zhou, Jian; Zhao, Yong; Xing, X.-D.; Li, Gongjie

doi:10.1259/bjr.20130035

Cited by 12 publications

(13 citation statements)

References 19 publications

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“…The percentage of abnormal pulmonary CT imaging in the survivor group was lower than the non-survivor group (41.88% vs 57.45%, p = 0.025) in our study, the lesions were consisted of pulmonary segment involvement, effusion, consolidation and brosis, or rapid lesion progression. Previous study reported that CT imaging could be a prognostic indicator for patients with pulmonary injury from acute PQ poisoning [17]. However, Cox regression analysis in the present study could not identify it as an independent risk factor for the prognosis.…”

Section: Discussioncontrasting

confidence: 90%

Analysis of Prognostic Factors in Patients with Paraquat Poisoning for Better Therapy Regimen

Xü

Chen

et al. 2020

Preprint

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Background Paraquat poisoning is associated with very high mortality rate and extremely difficult to manage due to lack of antidotes. The purpose of this study was to identify prognostic factors after paraquat poisoning and discuss the efficacy of current therapy regimen. Methods In this retrospective study, 211 paraquat poisoning cases admitted to the First Affiliated Hospital, School of Medicine, Zhejiang University between 1 June 2010 and 30 April 2016 were enrolled. The demographic characteristic, medical records of clinical features, laboratory parameters, therapy regimen and the prognosis were analyzed. Results The overall survival rate was 55.45%. the mean age was 35.85 years old. Twelve patients who ingested paraquat combined with alcohol had a higher survival rate. The patients in survival group ingested less amount of paraquat, presented with lower serum creatinine level at admission, developed lower incidence of acute kidney injury and pulmonary CT deterioration. The survivors were treated with higher dosage of methylprednisolone, daily dose of aspirin, daily dose of rapamycin and lower dose of vitamin C. The frequency of hemoperfusion was much more in the survival group. The Cox regression survival analysis demonstrated larger amount of paraquat ingestion, abnormal renal function at admission or developing acute kidney injury (AKI) after admission were independent risk factors for mortality. Higher dose of methylprednisolone and aspirin were independent protective prognostic factors. Conclusions Non-survivor characteristics are larger amount of paraquat ingestion, manifestation of abnormal renal function at admission or developing AKI after admission, whereas the survivor characteristics are higher dose of methylprednisolone and aspirin.

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Section: Discussioncontrasting

confidence: 90%

Analysis of Prognostic Factors in Patients with Paraquat Poisoning for Better Therapy Regimen

Xü

Chen

et al. 2020

Preprint

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“…In the present study, the ROC curve of leucocyte displayed an AUC of 0.961, which is higher than that in previous report [ 17 ] because of short poisoning time (within 8 h) after ingestion in this study. In addition, Some toxicity signs, such as renal failure [ 18 ], high lactate [ 18 ], high APACHE II score[ 18 ], high lymphocyte count [ 5 ], peripheral burning sensation [ 19 ], changes on chest radiograph [ 20 ], gastrointestinal lesion [ 21 ], hypotension, severe hypoxia, acidosis, and low Glasgow Coma Scale [ 22 ] are used to differentiate those who are likely to succumb eventually from survivors. However, the use of sensory data may not provides highly reliable and accurate estimates of severity of their poisoning.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning

Feng

Gao

2018

PLoS ONE

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The aim of this study is the identification of a reliable predictor of prognosis to optimize the treatment of acute paraquat (PQ) poisoning patients. We performed a retrospective analysis on 96 patients with acute PQ poisoning to evaluate leucocyte count as a predictor of 90-day survival. These patients were admitted to the emergency department from May 2012 to February 2017. Kaplan–Meier method was used to compare the 90-day survival. Cox proportional hazard models were utilized to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of leucocyte with respect to 90-day survival. Result showed that leucocyte was significantly higher among nonsurvivors than that among survivors (p<0.001). Leukocyte was also an independent predictor of survival according to the multivariate Cox analysis (HR 1.103; 95%CI: 1.062–1.146; p<0.001). The area under the curve (AUC) for leucocyte (AUC 0.911; 95%CI: 0.855–0.966; p<0.001) showed a discriminatory potential similar to that of the plasma PQ concentration (AUC 0.961; 95%CI: 0.926–0.997; p<0.001) in predicting 90-day survival. The leucocyte count is a strong predictor of survival in patients with acute PQ poisoning.

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“…We find HRCT as a best modality in fully evaluating the extent of acute PQ lung injury ( Fig. 3 ) ( 30 , 31 , 32 ).…”

Section: Diagnosismentioning

confidence: 97%

Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication

et al. 2014

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Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.

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CT imaging as a prognostic indicator for patients with pulmonary injury from acute paraquat poisoning

Abstract: Xing X, et al. CT imaging as a prognostic indicator for patients with pulmonary injury from acute paraquat poisoning. Br J Radiol 2013;86:20130035.

Cited by 12 publications

References 19 publications

Analysis of Prognostic Factors in Patients with Paraquat Poisoning for Better Therapy Regimen

Analysis of Prognostic Factors in Patients with Paraquat Poisoning for Better Therapy Regimen

A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning

Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication

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