Correlation of serum acetylcholinesterase with the ventilation need, ICU stay and outcome in organophosphorus poisoning - a retrospective study

Background: World Health Organization has estimated that 3 million cases of pesticide poisoning are registered every year. Southern states of India have high prevalence rate of organophosphorus poisoning [OPP] due to many factors, including accidental, suicidal or homicidal intentions. Various clinical and laboratory tests are used to assess severity of the poisoning, but with conflicting results. This study aimed to correlate the serum acetylcholinesterase levels with morbidity, ventilation need, ICU stay and the final outcome of the ailment

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Methodology: This retrospective study was conducted in rural tertiary care of Maharashtra, India. The patients admitted from 1st January 2016 to 31st December 2016 with definitive diagnosis of OPP requiring mechanical ventilator support were included. Parameters like age, sex, serum acetylcholinesterase levels, ventilator days, ICU stay days and outcome were collected. Patients with unknown compound poisoning, referred from other hospital or brought dead were excluded. The statistical analysis was done by using Graph Pad software. Unpaired t test was used for parametric values. Pearson's correlation test was used for correlating the values of serum cholinesterase levels with ventilator hours and ICU stay

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Results: Out of a total of 257 patients, 32 fulfilled inclusion criteria; 25 [78%] were males of whom 10 [40%] patients died, and 7 [22%] were females of whom 2 [28.5%] could not be saved. The male to female ratio was 3.6:1.The lowest and highest recorded serum acetylcholinesterase level was 178 and 6358 U/L respectively. The average ventilator hours were 66.56 +/- 44.73, age distribution was 43.28 +/- 16, average number of ICU stay was found to be 10.4 +/- 19.68 days

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Conclusion: The prediction of morbidity or outcome, ICU stay and ventilator days cannot be made based on the levels of serum acetylcholinesterase