Association of Serum Cholinesterase and Liver Enzymes with Clinical Severity and Outcomes in Organophosphorus Poisoning

Abstract

Abstract Background: Organophosphorus (OP) compound poisoning is a medico-toxic emergency that results in multiorgan failure. The primary mechanism of action is by inhibition of acetylcholinesterase, leading to disruption in processes of oxidative stress, apoptosis, and microsomal metabolism resulting in liver toxicity. The present study was conducted to explore the prognostic value of serum cholinesterase in predicting severity of organophosphorous compound poisoning and the need for ventilatory support; and to understand the role of aspartate aminotransaminase (AST), alanine aminotransaminase (ALT) and bilirubin in assessing the severity of acute organophosphate poisoning. Methodology: Hospital-based prospective observational study was conducted among OP poisoning cases at a tertiary hospital in Hubli. Clinical examination was done during the initial resuscitation and treatment of patients. Three milliliter of plain blood was collected on admission before administration of atropine and plasma cholinesterase level, and other biochemical parameters were estimated. Results: Sixty-five percent of poisoning cases had >50% of cholinesterase activity with normal grade poisoning. Moderate and severe grade poisonings were present among 3% and 5% of poisoning cases, respectively. Patients with cholinesterase level activity of ≤50% had significantly higher proportions of respiratory failure (77%) and fatal outcomes (33%). Median levels of AST (Q2: 73.2 IU/mL) and ALT were significantly higher (Q2: 22.7 IU/L) among severe grade poisoning (Che: <10%) compared to other grades of poisoning. Conclusion: The assessment of cholinesterase level activity in OP poisoning would be a useful guide to the physician for planning of intensive care, duration of hospital stay, and clinical prognosis. Serum AST and ALT levels can also contribute as supportive biomarkers to assess the severity, chances of respiratory failure, and clinical outcomes of OP poisoning.