Abstract
BackgroundThousands of paraquat (PQ)-poisoned patients continue to die, particularly in developing countries. Although animal studies indicate that hemoperfusion (HP) within 2−4 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown.MethodsWe analyzed the records of all PQ-poisoned patients admitted to 2 hospitals between 2000 and 2009. Patients were grouped according to early or late HP and high-dose (oral cyclophosphamide [CP] and intravenous dexamethasone [DX]) or repeated pulse (intravenous methylprednisolone [MP] and CP, followed by DX and repeated MP and/or CP) PQ therapy. Early HP was defined as HP <4 h, and late HP, as HP ≥4 h after PQ ingestion. We evaluated the associations between HP <4 h, <5 h, <6 h, and <7 h after PQ ingestion and the outcomes. Demographic, clinical, laboratory, and mortality data were analyzed.ResultsThe study included 207 severely PQ-poisoned patients. Forward stepwise multivariate Cox hazard regression analysis showed that early HP <4 h (hazard ratio [HR] = 0.38, 95% confidence interval (CI) 0.16–0.86; P = 0.020) or HP <5 h (HR = 0.60, 95% CI: 0.39–0.92; P = 0.019) significantly decreased the mortality risk. Further analysis showed that early HP reduced the mortality risk only in patients treated with repeated pulse therapy (n = 136), but not high-dose therapy (n = 71). Forward stepwise multivariate Cox hazard regression analysis showed that HP <4.0 h (HR = 0.19, 95% CI: 0.05–0.79; P = 0.022) or <5.0 h (HR = 0.49, 95% CI: 0.24–0.98; P = 0.043) after PQ ingestion significantly decreased the mortality risk in repeated pulse therapy patients, after adjustment for relevant variables.ConclusionThe results showed that early HP after PQ exposure might be effective in reducing mortality in severely poisoned patients, particularly in those treated with repeated pulse therapy.
Highlights
Paraquat (PQ) (1,19-dimethyl-4,49-bipyridium dichloride) is one of the most widely used herbicides in the world
A navy blue ($25 ppm and,50 ppm) or dark blue ($50 ppm) color detected from the urine test within 24 h after PQ ingestion generally indicates severe PQ poisoning, which is associated with poor outcome and high mortality in these patients
These findings suggested that urine PQ tests within the first 24 h of exposure are good predictors of outcome, as navy blue and dark blue color in urine tests indicated severe PQ poisoning; colorless and light blue color in urine tests indicated mild to moderate PQ poisoning
Summary
Paraquat (PQ) (1,19-dimethyl-4,49-bipyridium dichloride) is one of the most widely used herbicides in the world. Another study [4] demonstrated that 65 severely PQ-poisoned patients, indicated by navy blue and dark blue colored urine test results, had an 81.5% (53/65) mortality rate, despite administration of conventional high-dose cyclophosphamide (CP) and dexamethasone (DX) treatments for PQ intoxication. Another study [5] of blood filtration in treating PQ-poisoned patients indicated that patients with dark blue colored urine test results within 24 h following ingestion had 97% mortality rates (32/33). Taken together, these findings suggested that urine PQ tests within the first 24 h of exposure are good predictors of outcome, as navy blue and dark blue color in urine tests indicated severe PQ poisoning; colorless and light blue color in urine tests indicated mild to moderate PQ poisoning. Animal studies indicate that hemoperfusion (HP) within 224 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown
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