Prognostic Value of Plasma and Urine Paraquat Concentration

Scherrmann, Jean Michel; Houzé, Pascal; Bismuth, C; Bourdon, R

doi:10.1177/096032718700600116

Cited by 131 publications

(100 citation statements)

References 3 publications

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“…Early prognosis of PQ poisoning is significant for both patients and doctors [3]. Studies have shown that the mortality rate of PQ poisoning is highly correlated with ingested PQ amount or PQ concentrations in plasma and urine (within 4-24 hr elapsed from ingestion) [4,5]. Hsu et al [6] found that early haemoperfusion (HP) after PQ exposure may reduce the mortality specifically and that HP <4.0 or <5.0 hr can reduce the relative risk of mortality by approximately 81% or 51%, respectively.…”

Section: Paraquat (11mentioning

confidence: 99%

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

Chen

et al. 2016

Basic Clin Pharma Tox

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The early identification of toxic paraquat (PQ) poisoning in patients is critical to ensure timely and accurate prognosis. Although plasma PQ concentration has been reported as a clinical indicator of PQ poisoning, it is not commonly applied in practice due to the inconvenient necessary instruments and operation. In this study, we explored the use of blood routine indexes to identify the degree of PQ toxicity and/or diagnose PQ poisoning in patients via machine learning approach. Specifically, we developed a method based on support vector machine combined with the feature selection technique to accurately predict PQ poisoning risk status, then tested the method on 79 (42 male and 37 female; 41 living and 38 deceased) patients. The detection method was rigorously evaluated against a real-world data set to determine its accuracy, sensitivity and specificity. Feature selection was also applied to identify the factors correlated with risk status, and the results showed that there are significant differences in blood routine indexes between dead and living PQ-poisoned individuals (p-value < 0.01). Feature selection also showed that the most important correlated indexes are white blood cell and neutrophils. In conclusion, the toxicity or prognosis of PQ poisoning can be preliminarily ascertained by blood routine testing without PQ concentration data, representing an additional tool and innovative approach to assess the prognosis of PQ poisoning.of the most commonly used herbicides in the world, is considerably more toxic to human beings than other herbicidal agents. Acute ingestion of 7-8 mL PQ can cause severe liver, lung and kidney issues and even heart failure leading to death [1]; the mortality of PQ poisoning is 60-70% [2]. Many people have been poisoned by PQ throughout many years and across the world, although the problem is especially serious in developing countries. Early prognosis of PQ poisoning is significant for both patients and doctors [3]. Studies have shown that the mortality rate of PQ poisoning is highly correlated with ingested PQ amount or PQ concentrations in plasma and urine (within 4-24 hr elapsed from ingestion) [4,5]. Hsu et al. [6] found that early haemoperfusion (HP) after PQ exposure may reduce the mortality specifically and that HP <4.0 or <5.0 hr can reduce the relative risk of mortality by approximately 81% or 51%, respectively.Although PQ concentration has proven effective in terms of PQ poisoning diagnosis and prognosis, it is seldom applied in clinics [7,8] because it must be determined by HPLC or LC-MS, which requires highly accurate equipment [9,10].Although sodium dithionite, sodium hydroxide and spectrophotometry can be used to determine PQ concentration, they are simple qualitative assays and cannot provide the accurate level of PQ concentration. Consequently, PQ concentration is generally not available as a routine test option in hospitals.The blood routine test (BRT), also named complete blood count, which includes many indexes such as white blood cell (WBC), red blo...

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Section: Paraquat (11mentioning

confidence: 99%

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

Chen

et al. 2016

Basic Clin Pharma Tox

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“…7 PQ-poisoned patients whose urine PQ concentrations 24 h after ingestion ranged from 25 to 50 ppm (as well as those with poisoning over 50 ppm) experienced an 88.9% mortality rate due to the lack of a proper antidote. 8 At present, physicians treat PQ-poisoned patients on the spot with a standard PQ detoxification protocol in accordance with the detection results from a urine sodium dithionite assay and PQ poisoning symptoms. [9][10][11] However, a urine sodium dithionite assay cannot accurately reflect PQ poisoning prognosis in patients.…”

Section: Introductionmentioning

confidence: 99%

Paper-based diagnostic devices for clinical paraquat poisoning diagnosis

et al. 2016

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This article unveils the development of a paper-based analytical device designed to rapidly detect and clinically diagnose paraquat (PQ) poisoning. Using wax printing technology, we fabricated a PQ detection device by pattering hydrophobic boundaries on paper. This PQ detection device employs a colorimetric sodium dithionite assay or an ascorbic acid assay to indicate the PQ level in a buffer system or in a human serum system in 10 min. In this test, colorimetric changes, blue in color, were observable with the naked eye. By curve fitting models of sodium dithionite and ascorbic acid assays in normal human serum, we evaluated serum PQ levels for five PQ-poisoned patients before hemoperfusion (HP) treatment and one PQpoisoned patient after HP treatment. As evidenced by similar detection outcomes, the analytical performance of our device can compete with that of the highest clinical standard, i.e., spectrophotometry, with less complicated sample preparation and with more rapid results. Accordingly, we believe that our rapid PQ detection can benefit physicians determining timely treatment strategies for PQ-poisoned patients once they are taken to hospitals, and that this approach will increase survival rates.Published by AIP Publishing. [http://dx

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“…Our paraquat-poisoned patient presented most of the validated indicators of poor outcome, including suicidal ingestion, ingestion of a large quantity (one mouthful of a 20% solution is potentially life-threatening), the presence of gastritis at gastroscopic examination, an early renal dysfunction, and elevated plasma paraquat concentration related to time of ingestion [1,8]. According to the survival probability employing Proudfoot's criteria [9] or Scherrmann's predictive value of plasma paraquat concentration [10], this patient was initially classified as likely to die. According to the Hart nomogram [11], his predicted survival rate was of 20-30%.…”

Section: Discussionmentioning

confidence: 99%

Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

et al. 2009

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Introduction: Combined glucocorticoids and cyclophosphamide pulse therapy showed promising results in moderate-to-severe paraquat poisonings to reduce life-threatening respiratory complications. Its benefit has been observed when given early in the course of poisoning; however, whether its delayed administration remains beneficial is unknown.Case Report: We describe a 23-year-old male who ingested 70 mL of a commercialized concentrate formulation with 20% weight/volume paraquat in a suicide attempt. Within 24 hours from paraquat ingestion, he presented most of the indicators of poor outcome, including gastritis, early renal dysfunction, dark blue urine colorimetric dithionite test, and marked plasma paraquat concentrations (0.56 g/mL at 13 hours, and 0.41 g/mL at 24 hours after ingestion). The patient received early gastrointestinal decontamination and aggressive supportive treatments. However, due to a rapidly progressive severe pulmonary infection, glucocorticoids and cyclophosphamide were delayed until day 14. Interestingly, our patient survived with mild respiratory sequelae despite poor initial prognosis.Discussion: This observation suggests the potential benefit of immunosuppressive pulse therapy, even if administered 14 days after paraquat ingestion, and highlights the role of paraquat-induced alveolitis in the development of fibrosis.Conclusion: Combined glucocorticoids and cyclophosphamide should be considered in moderate-to-severe paraquat poisonings, even if delayed.

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Prognostic Value of Plasma and Urine Paraquat Concentration

Cited by 131 publications

References 3 publications

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

Paper-based diagnostic devices for clinical paraquat poisoning diagnosis

Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

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