Abstract
Background: Rodenticide paste containing Yellow phosphorous(YP)poisoning is very common in South India,. The incidence of hepatotoxicity and acute liver failure(ALF) is around 40%. Although therapeutic plasmapheresis(PLEX)has been established as a grade 1 recommendation in ALF, there are few such studies in this context. Our objective: was to study the efficacy of PLEXs in ALF due to YP poisoning and to evaluate the predictive factors in determining its success. Methods: A total of 53 patients underwent plasmapheresis for ALF due to YP poisoning, over two years (December 2018-December 2020). Demographic data and biochemical parameters were recorded before and after. Overall total and liver transplant(LT)- free survival was analyzed. Results: Of all patients, (67%) completely recovered, while 6% worsened, and was transferred to transplant units,with some undergoing LT ,while 13% were discharged against medical advice, and the rest expired(14%). The study showed mean significant improvement in Total Leukocyte Count (Before and after plasmapheresis Total leucocyte count(TLC) Mean±Std were 4638±2820 ; 6130±2274 P=<0.003*), total bilirubin (Before and after plasmapheresis total bilirubin mean±Std were 3.7± 3; 2.2±1.9, P=0.003*), SGOT (Before and after plasmapheresis SGOT mean±Std were 252±136; 48±33, P=0.01∗), and international normalized ratio (Before and after plasmapheresis INR mean±Std were 2.1± 1.4 ;1.8 ± 1.1, P=0.024*) (P < 0.05) . A significant association was noted between success of treatment on time taken to reach the treatment facility and the quantity of toxin consumed. It was also noted that leukopenia, due to toxin-induced myelosuppression was a major independent predictor of mortality and and, preceded hepatic manifestations like transaminitis and coagulopathy. Early initiation of PLEX in such patients, was found to have significant survival benefits. Conclusion: Therapeutic PLEX appears to be a novel intervention providing survival benefit in patients with ALF due to YP poisoning and appears a feasible nontransplant treatment option especially in a resource-constrained setting,
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