Prolonged methylprednisolone therapy after the pulse treatment for patients with moderate-to-severe paraquat poisoning

Abstract

This retrospective study aims to evaluate the effect of prolonged methylprednisolone (MP) therapy on the mortality of patients with moderate-to-severe paraquat (PQ) poisoning after the pulse treatment.We performed a retrospective analysis of patients with acute moderate-to-severe PQ poisoning that were admitted to the emergency department from May 2012 to August 2016. Out of 138 patients, 60 were treated with pulse treatment (15 mg kg–1 day–1 MP for 3 days) and 78 were treated with prolonged MP therapy after pulse treatment (15 mg kg–1 day–1 MP for 3 days; afterward, the dosage was reduced in half every 2 days, and the MP therapy was terminated until 0.47 mg kg–1 day–1). Kaplan–Meier method was used to compare the mortality between the 2 groups. Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI).The mortality of the prolonged MP therapy after pulse treatment group was lower than that of the pulse group (47.4% vs 63.3%; log-rank tests, P = .003). According to the multivariate Cox analysis, the prolonged MP therapy after pulse treatment was significantly associated with a lower mortality risk (HR: 0.31, 95% CI: 0.19–0.52, P < .001) compared with the pulse group. In addition, the prolonged MP therapy after pulse treatment caused more incidences of leucopenia than the pulse treatment alone (25.6% vs 11.7%, P = .04).The prolonged MP therapy after pulse treatment can reduce the mortality of moderate-to-severe PQ poisoning patients.

Immunosuppressive drugs to reduce the mortality rate in patients with moderate to severe paraquat poisoning: A Meta-analysis

“…However, these two studies lacked a control group, so it was difficult to draw firm conclusions and therefore we excluded these two studies to ensure the credibility of our study. In some other observational studies, the study by Jie Gao et al states that prolonged MP therapy after pulse treatment can reduce the mortality of moderate-to-severe PQ poisoning patients (Gao et al, 2017). Early hemoperfusion may improve the survival chances of PQ poisoning patients, as was confirmed in three studies (Gao et al, 2015;Hsu et al, 2012;Wang et al, 2017).…”

Patients with mild paraquat poisoning treated with prolonged low-dose methylprednisolone have better lung function

“…Feng et al [ 11 ] reported that prolonged MP treatment after pulse therapy for PQ-intoxicated rats can effectively ameliorate acute lung injury. Subsequently, Gao et al [ 7 ] performed a retrospective analysis and demonstrated that prolonged MP therapy after pulse treatment can reduce mortality in patients with moderate-to-severe PQ poisoning. Conversely, Perriëns et al [ 12 ] failed to find any significant difference in respiratory failure and survival rates.…”

“…According to the therapeutic regimens, all enrolled patients fell into one of the following groups: short-term MP group: (3 mg/kg/day intravenous MP for three consecutive days), [ 6 ] and prolonged low-dose MP group: (3 mg/kg/day MP for 3 days, followed by dosage reduction by half every 3 days, with MP treatment terminated when 0.375 mg/kg/day was reached). [ 7 ] Lung function was evaluated at 2 to 3 months after PQ exposure.…”

Base excess in predicting the prognosis of patients with paraquat poisoning

“…Although previous studies have investigated various treatment modalities for acute PQ poisoning, the fatality rate remains high, with affected individuals presenting a mortality rate of 50% to 90%. [1–3] Thus, biomarkers for the prognosis and clinical monitoring of acute PQ poisoning must be urgently developed for the formulation of appropriate treatment plans and develop future PQ antidotes.…”