Early Stage Blood Purification for Paraquat Poisoning: A Multicenter Retrospective Study

Abstract

Objectives: To evaluate the efficacy of conservative treatment vs. hemoperfusion (HP) vs. HP + continuous veno-venous hemofiltration (CVVH) for acute Paraquat (PQ) poisoning. Methods: This was a multicenter retrospective study of patients with PQ poisoning between January 2013 and June 2014. Clinical data and PQ serum levels were collected at baseline and after 24, 48, and 72 h of treatment. Results: Seventy-five, 65, and 43 underwent conservative treatment only (conservative treatment group), conservative treatment + HP (HP group), and conservative treatment + HP + CVVH (HP + CVVH group), respectively. PQ serum levels decreased in all groups after 72 h of treatment (p < 0.001); meanwhile, these values decreased faster in the HP and HP + CVVH groups compared with the conservative treatment group. More importantly, PQ blood levels were significantly lower in the HP + CVVH group compared with the HP group at 24 h (p < 0.05). Sequential organ failure assessment (ΔSOFA) values in the HP and HP + CVVH groups were significantly lower compared with that obtained for the conservative treatment group (p < 0.05). The 60-day survival rates were 21.3, 43.1 and 46.5%, respectively. Multivariate analysis indicated that age, PQ dose, admission PQ levels, and admission SOFA score were independently associated with mortality. HP and HP + CVVH were protective factors. Conclusion: Early HP or HP + CVVH after PQ poisoning could decrease PQ blood levels, alleviate organ damage, and increase survival.

The Successful Treatment of High Lethal Dose ‎Paraquat Poisoning With Hemoperfusion

“…Young age, percutaneous or inhalational route, negative PQ test, exposure to less PQ, and fewer degrees of leukocytosis, acidosis, renal, hepatic, and pancreatic failures on admission are good prognostic factors. PQ ingestion may provide late complications, such as oropharyngeal ulceration, esophageal erosions, esophagitis, renal failure, pulmonary fibrosis, and strictures [12,13].…”

“…The survival of our patient could be explained by several episodes of vomiting; the lack of any lung, pancreatic, or hepatic failure, acidosis, or other severe End Organ damage due to the early management of preventing the poison absorption, and prompt initiation of favorable supportive treatment. The most important of all, the rapid start of hemoperfusion with hemodialysis could be highly effective [6,12].…”

Does Hemoperfusion Increase Survival in Acute Paraquat Poisoning? A Retrospective Multicenter Study

“…Recently, several cohort studies have suggested a survival benefit when comparing HP to medications alone in PQ-poisoned patients [10][11][12][13]. Many of these studies demonstrated that early initiation (within 4-6 h) of HP after acute PQ ingestion might improve the survival of PQ-poisoned patients [10,12,13].…”

“…However, these studies may have limitations as the authors did not clearly stratify patients by poisoning severity or account for other interventions [12,13]. For example, some studies did not report the elapsed time to the first HP, and these studies did not include immunosuppressants or antioxidants as part of the therapy [11]. Additionally, these studies were conducted in developing countries such as China or India, where care may be delayed, especially in rural areas [11,13].…”

Continuous venovenous hemofiltration in the management of paraquat poisoning

“…[13–17] Compared to HP, continuous venovenous hemofiltration (CVVH), the most commonly used type of continuous renal replacement therapy, possesses diffusive, convective, and adsorptive functions. [18,19] Theoretically, these features of CVVH cannot only help remove the toxin from the blood, but can also help clear the large number of inflammatory mediators and inflammatory factors produced upon PQ poisoning. However, although CVVH has already been applied for the treatment of PQ poisoning in clinical practice, its efficacy remains controversial.…”