Abstract
The aim of this study is the identification of a reliable predictor of prognosis to optimize the treatment of acute paraquat (PQ) poisoning patients. We performed a retrospective analysis on 96 patients with acute PQ poisoning to evaluate leucocyte count as a predictor of 90-day survival. These patients were admitted to the emergency department from May 2012 to February 2017. Kaplan–Meier method was used to compare the 90-day survival. Cox proportional hazard models were utilized to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of leucocyte with respect to 90-day survival. Result showed that leucocyte was significantly higher among nonsurvivors than that among survivors (p<0.001). Leukocyte was also an independent predictor of survival according to the multivariate Cox analysis (HR 1.103; 95%CI: 1.062–1.146; p<0.001). The area under the curve (AUC) for leucocyte (AUC 0.911; 95%CI: 0.855–0.966; p<0.001) showed a discriminatory potential similar to that of the plasma PQ concentration (AUC 0.961; 95%CI: 0.926–0.997; p<0.001) in predicting 90-day survival. The leucocyte count is a strong predictor of survival in patients with acute PQ poisoning.
Highlights
Paraquat (N,N0-dimethyl–4,40–bipyridinium dichloride; PQ) is a widely used effective herbicide with favorable environmental characteristics and cost effectiveness
PQ poisoning exhibits low survival rate, especially in patients with moderate to severe poisoning; this poisoning may result in acute renal failure, hepatitis, and pulmonary fibrosis, which often lead to death within several weeks
The Receiver operating characteristic (ROC) curve of leucocyte showed an area under the curve (AUC) of 0.911
Summary
Paraquat (N,N0-dimethyl–4,40–bipyridinium dichloride; PQ) is a widely used effective herbicide with favorable environmental characteristics and cost effectiveness. PQ poisoning exhibits low survival rate, especially in patients with moderate to severe poisoning; this poisoning may result in acute renal failure, hepatitis, and pulmonary fibrosis, which often lead to death within several weeks. Intentional self-poisoning with PQ is an important public health problem in the Asia–Pacific region with an estimated 300,000 deaths annually [1]. A reliable predictor of prognosis is useful for the future treatment of acute PQ poisoning patients. The early prediction of prognosis could allow a more suitable therapy for patients having the best predictable survival rate and stimulate new research for the treatment of patients, who have the intermediate or worst prognostic parameters [2].
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