The clinical value of combining early urine paraquat clearance rate with severity index of paraquat poisoning in predicting the prognosis for acute paraquat poisoning patients

Abstract

Objective To investigate the clinical value of combining early urine paraquat early clearance rate(UPCR)with severity index of paraquat poisoning(SIPP)in predicting the prognosis for paraquat poisoning patients. Methods In this retrospective research, a total of 425 cases diagnosed with acute paraquat poisoning from March 2014 to March 2016 in Emergency Intensive Care Unit, First Affiliated Hospital of China Medical University were enrolled. The general data of patients, the results of rapid qualitative test of paraquat in blood and urine, the concentration of paraquat in blood / urine, the poisoning time, the concentration of blood lactic acid and the APACHE Ⅱscore were collected. The early UPCR and SIPP were measured at different time intervals, and the ratio of 6-SIPP and 12 h-UPCR were calculated. These patients were divided into death groups and survival groups according to the 28-day mortality. The relationship between these factors and the mortality were analyzed. Results Of all the 425 patients, 268 cases(63.1%)died, 157 cases(36.9%) survived; the blood concentration of paraquat, the lactate concentration, SIPP values and the APACHE Ⅱ scores were significant difference between the two groups(P 0.05). The 6 h-SIPP/12 h-UPCR value was (41.94±5.9)in death group, which was higher than that in survival group(5.27±3.6)(P<0.05). Conclusion The combined use of early UPCR and SIPP values is an effective indicator of the prognosis of patients with acute paraquat poisoning and is helpful for the early stratification. We should pay more attention to the patients whose rapid qualitative blood test is positive because of their high mortality risk; for the patients whose 12 h urinequalitative test was negative, the hemoperfusion therapy might be stopped because the toxin was completely excluded, and the medical resources can be saved reasonably. The UPCR might indicate the excretion of toxins, and SIPP might indicate the severity of poising. Key words: Urine paraquat early clearance rate; Severity index of paraquat poisoning; Blood paraquat rapid qualitative test; Urine paraquat rapid qualitative test; Prognosis