Cao Zong Xun, Zhao Yong, Gao Jie, Feng Shun Yi, Wu Cheng Pu, Zhai Yan Zhao, Zhang Meng, Nie Shen, Li Yong
Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou 061000, China.
Medicine (Baltimore). 2020 Feb;99(6):e19063. doi: 10.1097/MD.0000000000019063.
Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning.
We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis.
Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95% CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis.
Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.
严重程度指数和血浆百草枯（PQ）浓度可预测PQ中毒患者的预后。然而，更好的参数尚未得到系统研究和确定。因此，我们进行了这项系统评价和荟萃分析，以研究严重程度指数和血浆PQ浓度对PQ中毒患者的预后价值。
我们检索了PubMed、Embase、Web of Science、ScienceDirect和Cochrane图书馆，以识别截至2019年3月发表的所有相关论文。所有比较严重程度指数和血浆PQ浓度以预测PQ中毒患者死亡率的诊断研究均纳入本荟萃分析。使用随机效应模型汇总各试验的比值比（OR）及其95%置信区间（CI）。我们还进行了异质性检验、敏感性分析和发表偏倚分析。
最终，纳入了7项涉及821例患者的研究。严重程度指数的合并OR及其95%CI为24.12（95%CI：9.34 - 62.34，P <.001），曲线下面积为0.88（95%CI：0.85 - 0.90），敏感性为0.84（95%CI：0.74 - 0.91），特异性为0.81（95%CI：0.75 - 0.87）。同时，血浆PQ浓度的合并OR及其95%CI为34.39（95%CI：14.69 - 80.56，P <.001），曲线下面积为0.94（95%CI：0.91 - 0.96），敏感性为0.86（95%CI：0.75 - 0.93），特异性为0.89（95%CI：0.76 - 0.95）。敏感性分析表明我们荟萃分析结果的稳定性。本荟萃分析未观察到明显的发表偏倚。
总体而言，本研究表明严重程度指数和血浆PQ浓度对PQ中毒患者具有较高的预后价值，且血浆PQ浓度的敏感性和特异性优于严重程度指数。
