The Area of Ground Glass Opacities of the Lungs as a Predictive Factor in Acute Paraquat Intoxication

Abstract

Even though plasma paraquat (PQ) levels have known to be an informative predictor, many patients succumb at low PQ levels in acute PQ intoxication. This study was designed to see whether the high resolution computerized tomography (HRCT) of the lungs would be a predictive measure in acute PQ intoxication. HRCT of the lungs was obtained from 119 patients with acute PQ intoxication on 7 days after PQ ingestion. The areas with ground glass opacities (GGOs) were evaluated at five levels with the area measurement tool of the picture archiving and communication systems. Among 119 patients, 102 survived and 17 died. The plasma PQ levels were significantly higher in the non-survivors than in the survivors (2.6±4.0 µg/mL vs. 0.2±0.4 µg/mL, P=0.02). The area with GGOs was 2.0±6.4% in the survivors and 73.0± 29.9% in the non-survivors (P<0.001). No patients survived when the area with GGOs was more than 40% but all of the patients survived when the area affected by GGOs was less than 20%. In conclusion, the area of GGOs is a useful predictor of survival in acute PQ intoxication, especially in patients with low plasma PQ levels.

Urinary paraquat concentration and white blood cell count as prognostic factors in paraquat poisoning

“…The volume of ingested PQ was determined on the basis of adult mouthful swallow, with a mean volume of approximately 20 mL, which is in agreement with previous reports [25][26][27]. However, in some instances, the precise amount of PQ ingested could not be confirmed especially for subjects who got exposed to PQ by drinking from a bowl, cup or glass.…”

The dose of cyclophosphamide for treating paraquat-induced rat lung injury

“…Because the extent of lung injury is very important for predicting patient mortality in clinical situations [28,29], it is noteworthy that CP attenuated the extent of PQ-induced lung lesions as determined by micro-CT images in our study. This finding has not been reported previously.…”

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

“…Serum levels of PQ have been widely used to assess the accumulation of dangerous lung uptake, which normally peaks 4-5 h following exposure, although some studies reported that maximum lung concentration occurs as late as 15 h after exposure [7]. Plasma PQ levels have long been considered the most valuable prognostic indicator, but they have been shown to be highly variable between individuals, necessitating further examination by CT scanning and other imaging methods [12,13]. Because the serum response time varies, investigation by tissue biopsy may yield more accurate results [14].…”