Abstract
Paraquat poisoning causes multiple organ injury and high mortality due to severe toxicity and lack of effective treatment. Xuebijing (XBJ) injection, a traditional Chinese medicine preparation of five Chinese herbs (Radix Salviae Miltiorrhiae, Rhizoma Chuanxiong, Flos Carthami, Angelica Sinensis and Radix Paeoniae Rubra), has an anti-inflammatory effect and is widely used in the treatment of sepsis. This retrospective study was designed to evaluate the effects of XBJ combined with conventional therapy on mortality risk of patients with acute paraquat poisoning. Out of 68 patients, 27 were treated with conventional therapy (control group) and 41 were treated with intravenous administration of XBJ (100 ml, twice a day, up to 7 days) plus conventional therapy (XBJ group). Vital organ function, survival time within 28 days and adverse events during the treatment were reviewed. Results indicated that XBJ treatment significantly increased median survival time among patients ingesting 10-30 ml of paraquat (P=0.02) compared with the control group. After adjustment for covariates, XBJ treatment was associated significantly with a lower mortality risk (adjusted HR 0.242, 95% CI 0.113 to 0.516, P=0.001) compared with the control group. Additionally, compared with Day 1, on Day 3 the value of PaO2/FiO2 was significantly decreased, and the values of serum alanine aminotransferase, creatinine and troponin T were significantly increased in the control group (all P<0.05), but these values were significant improved in the XBJ group (all P<0.05). Only one patient had skin rash with itch within 30 minutes after injection and no severe adverse events were found in the XBJ group. In conclusion, XBJ treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning, which may be attributed to improved function of vital organs with no severe adverse events.
Highlights
Paraquat is a widely used herbicide in agriculture
The Kaplan—Meier survival curves (Fig 2A) showed that median survival time was slightly increased from 5.0 days with conventional therapy to 13 days with XBJ treatment plus
We found that XBJ did not have a statistically significant benefit in reducing allcause mortality in patients with paraquat poisoning, which was consistent with the findings from a recent meta-analysis [30]
Summary
Paraquat is a widely used herbicide in agriculture. There are numerous cases of paraquat poisoning by oral ingestion either accidentally or intentionally. Xuebijing Treats Acute Paraquat Poisoning doi:10.1371/journal.pone.0123504.g001 ranges from 50% to 90%, with no specific anticdote [1]. Clinical manifestations and outcomes of acute paraquat poisoning depend on the volume of paraquat ingested orally. Patients are often treated aggressively with a conventional therapy including gastric lavage, fluid infusion, antioxidants, cyclophosphamide, corticosteroids and haemoperfusion [3]. Extracorporeal elimination such as haemoperfusion has been used clinically in treating acute paraquat poisoning despite its controversial effects [4,5]. The outcome of paraquat poisoning is still disappointing, with a high mortality [6]
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