The association of alcohol consumption with patient survival after organophosphate poisoning: a multicenter retrospective study

Abstract

Organophosphate (OP) intoxication remains a serious worldwide health concern, and many patients with acute OP intoxication have also consumed alcohol. Therefore, we evaluated the association of blood alcohol concentration (BAC) with mortality among patients with OP intoxication. We retrospectively reviewed records from 135 patients who were admitted to an emergency department (ED) for OP intoxication between January 2000 and December 2012. Factors that were associated with patient survival were identified via receiver operating characteristic curve, multiple logistic regression, and Kaplan-Meier survival analyses. Among 135 patients with acute OP poisoning, 112 patients survived (overall mortality rate: 17 %). The non-survivors also exhibited a significantly higher BAC, compared to the survivors [non-survivors: 192 mg/dL, interquartile range (IQR) 97-263 mg/dL vs. survivors: 80 mg/dL, IQR 0-166.75 mg/dL; p < 0.001]. A BAC cut-off value of 173 mg/dL provided an area under the curve of 0.744 [95 % confidence interval (CI) 0.661-0.815], a sensitivity of 65.2 %, and a specificity of 81.2 %. A BAC of >173 mg/dL was associated with a significantly increased risk of 6-month mortality in the multiple logistic regression model (odds ratio 4.92, 95 % CI 1.45-16.67, p = 0.001). The Cox proportional hazard model revealed that a BAC of >173 mg/dL provided a hazard ratio of 3.07 (95 % CI 1.19-7.96, p = 0.021). A BAC of >173 mg/dL is a risk factor for mortality among patients with OP intoxication.

Latent Class Trajectories of Biochemical Parameters and Their Relationship With Risk of Mortality Among Acute Organophosphorus Poisoning Patients

“…Trajectory analysis showed that two trajectories of creatinine (including high-declining and normal increasing) had a signi cant relationship with mortality among OP poisoning patients. These results were consistent with previous studies as high creatinine found a signi cant factor of mortality in multiple Asian studies from 2013 to 2018 including one of our urban cities [13,17,22,26,39]. Two of Asian studies reported risk of mortality on univariable analysis, patients having high creatinine level founds seven to eight times more likely to die [21,40], whereas in our study patients in normal-increasing trajectory were eighteen times and high-declining were twelve times more likely to die compared to the normal consistent creatinine level.…”

“…Our study showed four times and fteen times increased risk of mortality for normal increasing and extremely high remitting trajectories patients respectively, when compared with normal consistent urea trajectory. These results were somewhat supported by two Asian studies which shown high urea level was associated with mortality [17,39], and were contrasting with few European and Asian studies which shown urea was not a signi cant factor of mortality [13,22,26]. The LLPA shown in our study that high-remitting trajectory of sodium electrolyte was signi cantly associated with increased mortality among OP poisoning patients, however previous evidence shown no relationship between sodium and mortality among OP poisoning patients [13,26].…”

Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients – a latent class growth analysis

“…LCGA in our study indicated that the highremitting trajectory of respiratory rate was linked to mortality. However, these results were in contrast with previous studies, as high temperature and low respiratory rate have exhibited significance with mortality in multiple studies [26,47,49,50], though nonsignificance for respiratory rate [47] and temperature [48] was observed in a study of OP poisoning patients. Multiple studies have investigated vital signs but not PO 2 [47,50,51], whereas our study showed that a normal-remitting partial oxygen pressure trajectory is linked to an increased risk of mortality.…”

“…The result for SBP was in contrast with multiple studies showing that it was not associated with mortality [26,27,42] . The heart rate result was somewhat supported by European and Asian studies, which reported that a high heart rate is associated with mortality [27,42,47]; nonethelesss, it was not linked with mortality in two Asian studies [48,49] . Trajectories of body temperature and diastolic blood pressure did not show any significant relationship with mortality.…”

Relationship between alcohol co-ingestion and outcome in profenofos self-poisoning – A prospective case series

“…A recent retrospective study of 135 OP insecticide poisoned patients admitted to five South Korean hospitals reported that blood ethanol concentration correlated with survival (although data on dose and proportion of patients who had ingested alcohol data were not presented). Using receiver operating characteristic (ROC) analysis this study identified a blood alcohol concentration of 173 mg/dL that was independently associated with death (OR 4.9 [1.5 to 16.7]) [ 23 ]. This finding differs from the dimethoate study, in which controlling in the analysis for the dimethoate concentration removed any association with ethanol, indicating that the effect of ethanol was due to higher doses of ingested OP and not due to the ethanol itself.…”