Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis

Isfahani, Sheida Nasr; Farajzadegan, Ziba; Sabzghabaee, Ali Mohammad; Rahimi, Alireza; Samasamshariat, Shiva; Eizadi-Mood, Nastaran

doi:10.4103/jrms.jrms_478_18

Cited by 15 publications

(6 citation statements)

References 39 publications

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“…There is also no definite treatment for paraquat poisoning. 16,56 This study has some limitations. It was a single referral center study and results cannot be generalized to the whole country.…”

Section: Discussionmentioning

confidence: 95%

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study

et al. 2023

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Objectives: Intoxication with pesticides is a well-known public health problem. We aimed to describe the demographic and toxico-clinical characteristics and outcomes of patients with pesticide poisoning. Methods: This retrospective cross-sectional study was performed in Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. All patients with pesticide poisoning (insecticides, herbicides, fungicides, rodenticides, and acaricides) were evaluated. The patients’ demographic, toxicological, clinical, and laboratory findings from March 2016 until March 2021 were collected and analyzed. Results: During the study period, 25,659 patients with acute poisoning were admitted, of which, 1567 (6.1% of the total poisoning) with pesticide poisoning were included. The mean ± SD age of the patients was 31.34 ± 13.7 years and 55.3% were men (male/female ratio = 1.23). In approximately 75% of the patients, poisoning occurred by suicidal attempts, while in 14.3% ( n = 224), it was accidental. Insecticides caused about 51.30% of the poisonings. However, rodenticides were most commonly used in completed suicide attempts (79.9%). The frequency of previously attempted suicide, and self-harming was different among the patients with respect to the type of pesticide poisoning ( p < 0.05). Previous suicidal attempts (35.3%) and self-harming (17.3%) were reported more in patients poisoned with the combination of pesticides. Half of the patients were employed. Nausea and vomiting (56.7%, n = 889) were the most common clinical manifestations; 8.3% ( n = 130) of the patients died, 64 of whom had rodenticide poisoning. Conclusion: The prevalence of pesticide poisoning was relatively low; most were insecticide poisoning. Poisoning occurred most through attempted suicide. Rodenticides and herbicides had higher mortality rates than other pesticides. Patients with previously attempted suicide and self-harming behavior may use a combination of pesticides.

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Section: Discussionmentioning

confidence: 95%

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study

et al. 2023

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“…Early assessment of the prognosis of patients with PQ poisoning has remained a major challenge to clinicians. 28 This study showed that the plasma PQ concentration after the first perfusion had a good predictive value for the clinical outcome of patients with mild to moderate PQ poisoning (plasma concentration at admission ,5000 ng/mL), and the predictive ability was better than that of the plasma PQ concentration measured on admission. To the best of our knowledge, this is the first report in which the plasma PQ concentration after the first perfusion has been shown to predict the outcome of patients with PQ poisoning, which indicates an important clinical significance.…”

Section: Discussionmentioning

confidence: 66%

Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients

Tang

Chen

Qiu

et al. 2021

Therapeutic Drug Monitoring

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Background: Paraquat ( PQ) is very poisonous to humans and animals and there is no effective clinical antidote . The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies. Methods:The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by highperformance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed.Results: Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50-1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was ,516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was ,516 ng/mL in the death group was only 19%. Conclusions:The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.

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“…This study was conducted to investigate the efficacy of hemoperfusion as a hemoadsorption treatment for the removal of poisons[ 22 ] and circulatory cytokines in critically-ill patients with COVID-19 infection. Xu et al previously showed that HA330 cartridge by the same manufactures successfully improved ARDS in a porcine model.…”

Section: Discussionmentioning

confidence: 99%

Hemoperfusion in patients with severe COVID-19 respiratory failure, lifesaving or not?

Abbasi

Naderi

Amra

et al. 2021

Journal of Research in Medical Sciences

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Background: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The “cytokine storm” is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease. Materials and Methods: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case–control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV. Results: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2/FIO2, high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%). Conclusion: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.

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Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis

Cited by 15 publications

References 39 publications

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study

Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients

Hemoperfusion in patients with severe COVID-19 respiratory failure, lifesaving or not?

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