Predictors of survival after acute paraquat poisoning

Abstract

Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning. Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1'-dimethyl-4,4'-bipyridium dichloride) ingested was 45.6 +/- 74.1 mL (mean +/- SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.

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

“…However, mortality may be reduced by accurately assessing the extent of disease progression, which varies highly from one individual to another. In fact, case studies by Lee et al [4] suggest that lung damage may not be irreversible if treated early. Thus, identification of lesions in the lungs and their severity may be crucial to improve patients' outcomes, especially since the number of lung lesions has been associated with greater mortality rates in these patients [20].…”

“…The prognosis is generally associated with the degree of exposure. Although many patients survive moderate inhalation and subcutaneous exposure, only 55.5% survive oral ingestion of a 25% PQ solution, roughly equivalent to the commercially available 24.6% solution [4]. Thus, only 7-8 ml of the commercial grade herbicide solution is necessary to achieve severe poisoning, with survival rates of ,13% without treatment and of only 73% with immediate treatment [5].…”

“…Previous studies have also linked certain patient characteristics, including age, respiratory rate, haemoglobin and presence of organ failure, with prognosis following acute PQ poisoning [4]. Immediate treatment with anti-oxidants (such as vitamins C and E), glucocorticoids, cytotoxic agents and certain forms of newly developed antifibrotic agents can improve the prognosis [10].…”

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…”

A study on clinical profile of paraquat poisoning in a tertiary care hospital

“…In hospital cases, fatality rate ranges between 35-62% around the world. 5,6 Also majority of the patients did not reach the hospital in the golden hour due to varied reasons. This shows that in India, we still have much to do to reduce the mortality associated with paraquat poisoning.…”