Abstract
Paraquat poisoning associates very high mortality rate. Early treatment with hemoperfusion is strongly suggested by animal and human studies. Although the survival benefit of additional immunosuppressive treatment (IST) in combination with hemoperfusion is also reported since 1971, the large-scale randomized control trials to confirm the effects of IST is difficult to be executed. Therefore, we designed this nationwide large-scale population-based retrospective cohort study to investigate the outcome of paraquat poisoning with hemoperfusion and the additional effects of IST combined with hemoperfusion. This nationwide retrospective cohort study utilized data retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. A total of 1811 hospitalized patients with a diagnosis of paraquat poisoning who received hemoperfusion between 1997 and 2009 were enrolled. The mean age of all 1811 study subjects was 47.3 years. 70% was male. The overall survival rate was only 26.4%. Respiratory failure and renal failure were diagnosed in 56.2% and 36% patients. The average frequency of hemoperfusion was twice. IST was added in 42.2% patients. IST significantly increases survival rate (from 24.3% to 29.3%, P<0.001). The combined IST with methylprednisolone, cyclophosphamide and dexamethasone associates with the highest survival rate (48%, P<0.001). Moreover, patients younger than 45 years of age in the IST group had the best survival (41.0% vs. 33.7%, p<0.001). Our results support the use of IST with hemoperfusion for paraquat-poisoned patients. The best survival effect of IST is the combination of methylprednisolone, cyclophosphamide and daily dexamethasone, especially in patients with younger age.
Highlights
IntroductionParaquat poisoning remains a major cause of death among patients with acute poisoning in developing countries [1]
Paraquat is a highly toxic herbicide that is used worldwide
Beyond the positive results from canine model of paraquat poisoning, Hsu and colleague reported that early hemoperfusion improves survival of severe paraquatpoisoned patients [8,9,10] Radiotherapy, desferoxamine, immunosuppressive treatment (IST), or vitamin E have been used with various success in paraquat poisoning, but the evidence is not strong [11,12,13,14,15]
Summary
Paraquat poisoning remains a major cause of death among patients with acute poisoning in developing countries [1]. Management of victims of paraquat poisoning includes activated charcoal administered via a nasogastric tube to prevent absorption by the gastrointestinal tract [3,4]. In order to increase the elimination of paraquat from plasma, the physicians often choose activated charcoal hemoperfusion therapy (6–8 hours) for 2 or more sessions [2,5,6,7]. Beyond the positive results from canine model of paraquat poisoning, Hsu and colleague reported that early hemoperfusion improves survival of severe paraquatpoisoned patients [8,9,10] Radiotherapy, desferoxamine, immunosuppressive treatment (IST), or vitamin E have been used with various success in paraquat poisoning, but the evidence is not strong [11,12,13,14,15]
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