Effect of hemoperfusion intensity on prognosis in patients with acute paraquat poisoning / 中华危重病急救医学

ABSTRACT

Objective To evaluate the influence of different hemoperfusion (HP) intensities on prognosis in patients with acute paraquat (PQ) poisoning. Methods The data of patients with acute PQ poisoning admitted to Department of Emergency of Shengjing Hospital Affiliated to China Medical University from January 2012 to February 2016 were retrospectively analyzed. Patients satisfied the following criteria were enrolled in the study adult patients, ingestion PQ within 12 hours and receiving HP treatment within 24 hours. Depending on the intensity of HP, patients were divided into lower intensity HP group (LHP, defined as receiving HP for less than 2 hours, 1 column) and higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients were divided into three groups, i.e. small dose ( 40 mL) poisoning groups on the basis of PQ ingestion volume. The baseline data of patients after hospital admission and arterial partial pressure of oxygen (PaO2), white blood cell (WBC), proportion of neutrophils (NEUT), alanine aminotransferase (ALT), total bilirubin (TBil), MB isoenzyme of creatine kinase (CK-MB), blood urea nitrogen (BUN) and serum creatinine (SCr) on the 4th day after hospital admission were compared, and 28-day mortality was followed up. Multiple logistic regression model was used to evaluate the characteristics of the dead patients within 28 days. The predictive value of each indicator for death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC). Results ① LHP group consisted 67 patients of 144 patients included with 24 in small dose group, 27 in medium dose group and 16 in high dose group. HHP group consisted of 77 patients with 28 in small dose group, 29 in medium dose group and 20 in high dose group. There were no significant differences in age, ingestion dose, time from poisoning to gastric lavage, and the time from the admission to HP between different intensities groups. ② Compared with LHP group, 28-day mortality in HHP group was significantly lowered (46.8% vs. 70.1%, χ2 = 8.032, P = 0.005). The patients receiving HHP in medium and small doses groups had lower 28-day mortality compared with those receiving LHP (41.4% vs. 74.1%, χ2 = 4.841, P = 0.017; 21.4% vs. 50.0%, χ2 = 4.661, P = 0.043). But there was no significant difference in 28-day mortality in high dose group between HHP and LHP (90.0% vs. 93.8%, χ2 = 0.000, P = 1.000). ③ The survival time of 12 patients with high dose poisoning was less than 72 hours, which were excluded for statistical analysis. Compared with LHP, the indexes of medium and small dose groups were obviously improved after HHP for 4 days. ④ Compared with survival group, PQ ingestion dose in non-survival group was increased, time from poisoning to gastric lavage and the time from the admission to HP were prolonged, and lower patients receiving HHP. ⑤ It was indicated by multiple logistic regression model that PQ ingestion dose [medium dose odds ratio (OR) = 0.018, 95% confidence interval (95%CI) = 0.004-0.085, P < 0.001; high dose OR = 0.075, 95%CI = 0.018-0.322, P < 0.001], time from poisoning to gastric lavage over 120 minutes (OR = 0.146, 95%CI = 0.045-0.470, P = 0.001), time from admission to HP over 4 hours (OR = 0.108, 95%CI = 0.029-0.395, P = 0.001), and LHP selection (OR = 0.363, 95%CI = 0.142-0.930, P = 0.035) were risk factors for the death at 28 days in patients with acute PQ poisoning. ⑥ It was shown by ROC curve that area under ROC curve (AUC) of PQ ingestion dose was 0.804 (95%CI = 0.723-0.885); when the cut-off value was 5.50 mL, the sensitivity was 94.0%, and the specificity was 65.6%. The AUC of time from poisoning to gastric lavage was 0.702 (95%CI = 0.617-0.786); when the cut-off value was 85.00 minutes, the sensitivity was 48.2%, and the specificity was 83.6%. AUC of time from the admission to HP was 0.719 (95%CI = 0.636-0.801); when the cut-off value was 3.50 hours, the sensitivity was 59.0%, and the specificity was 78.7%. Conclusions PQ ingestion dose, time from poisoning to gastric lavage, and time from the admission to HP are valuable factors for prognosis of the patients. HHP can improve the prognosis of patients with ingestion PQ less than 40 mL as early as possible, but for high dose group patients there was no much effect.