Does Hemoperfusion Increase Survival in Acute Paraquat Poisoning? A Retrospective Multicenter Study.

Ying-Tse Yeh,Hung-Tsang Yen,Chun-Kuei Chen,Chih-Chuan Lin,Yen-Chia Chen,Chorng-Kuang How,Kai-Ping Lan,Chia-Ming Chang

doi:10.3390/toxics8040084

Abstract

The efficacy of hemoperfusion (HP) in patients with acute paraquat poisoning (PQ) remains controversial. We conducted a multi-center retrospective study to include acute PQ-poisoned patients admitted to two tertiary medical centers between 2005 and 2015. We used the Severity Index of Paraquat Poisoning (SIPP) to stratify the severity of PQ-poisoned patients. The indication to start HP was a positive result for the semiquantitative urine PQ test and presentation to the hospital was within 24 h. Early HP was defined as the first session of HP performed within five hours of PQ ingestion. A total of 213 patients (100 HP group, 113 non-HP group) were eligible for the study. The overall 60-day mortality of poisoned patients was 75.6% (161/213). Multivariate Cox regression analysis showed no statistically significant difference in 60-day survival between HP and non-HP groups (95% confidence interval (CI): 0.84–1.63, p = 0.363). Further subgroup analysis in the HP group showed early HP (95% CI: 0.54–1.69, p = 0.880), and multiple secessions of HP (95% CI: 0.56–1.07, p = 0.124) were not significantly related to better survival. Among acute PQ-poisoned patients, this study found that HP was not associated with increased 60-day survival. Furthermore, neither early HP nor multiple secessions of HP were associated with survival.

Highlights

Paraquat (PQ; 1,10 -Dimethyl-4,40 -bipyridinium dichloride) is a non-selective herbicide, used primarily for weed and grass control since 1960 [1]
Of all the pesticide intoxication cases, including paraquat poisoning, organophosphate poisoning, carbamate poisoning, glyphosate poisoning, etc., we identified 320 patients (34%) with acute PQ
This study found that HP was not associated with increased survival of acute PQ-poisoned patients after adjustment for Severity Index of Paraquat Poisoning (SIPP), age, and renal function

Summary

Introduction

Paraquat (PQ; 1,10 -Dimethyl-4,40 -bipyridinium dichloride) is a non-selective herbicide, used primarily for weed and grass control since 1960 [1]. Paraquat accounts for 20 deaths per million persons [4]. In the United States, the US Environmental Protection Agency classifies PQ as “restricted use.”. Union and Korea have banned the use of PQ [4,5]. The initial therapy for PQ poisoning consists of gastrointestinal decontamination to prevent further absorption for oral exposures by using activated charcoal. This is followed by supportive care measures including enhanced elimination of serum PQ by hemoperfusion (HP) and medications inhibiting the Toxics 2020, 8, 84; doi:10.3390/toxics8040084 www.mdpi.com/journal/toxics

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