Abstract
Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO2 (P = 0.006) and higher alveolar-arterial O2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO2 at admission (P = 0.031), higher PaO2 at admission (P = 0.015), lower nadir PaCO2 (P = 0.001) and lower nadir HCO3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.
Highlights
Paraquat is a contact herbicide with extremely high toxicity
The mortality rate tended to be higher for acute kidney injury (AKI) HD patients than for non-AKI HD patients, this trend was not statistically significant (80.0% vs. 50.9%, P = 0.107, Table 2)
Multivariate logistic regression analysis demonstrated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.026) and higher PaO2 at admission (P = 0.014) were significant predictors of AKI (Table 3)
Summary
Paraquat is a contact herbicide with extremely high toxicity. In Taiwan, it is commonly ingested, whether deliberately or unintentionally [1]. Due to its severe toxicity, paraquat consumption is fatal in 60–80% of cases. Patients who have consumed about 40 mL of a 24% paraquat solution typically die of multiple organ failure in the few hours or days [2]. Paraquat is absorbed quickly, not completely, and is mostly excreted in the urine without further metabolism within 12–24 www.impactjournals.com/oncotarget hours. The characteristic clinical features of paraquat intoxication are acute lung injury and multiple organ failure, acute kidney injury (AKI) frequently occurs after acute large-dose exposure to this toxic herbicide [3]
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