Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, 613 004, India.
Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India.
Indian J Gastroenterol. 2021 Aug;40(4):373-379. doi: 10.1007/s12664-021-01178-4. Epub 2021 Jun 30.
Though rodenticidal hepatotoxicity is reported from India, there is no systematic study to assess its magnitude. This study aimed to assess exposure to rodenticide as a risk factor for acute hepatotoxicity in Tamil Nadu, India.
We retrospectively analyzed acute hepatotoxicity caused by ingestion of hepatotoxin or potentially hepatotoxic drug overdose across 15 hospitals in 6 districts of Tamil Nadu from 1 January 2019 to 30 June 2019. Study exclusion criteria were idiosyncratic drug-induced liver injury and chronic liver diseases.
Of the 702 patients, 685 gave history of consuming rodenticide; hepatotoxicity in the other patients resulted from paracetamol overdose (n=10) and due to other drugs (n=7); 97% patients had a suicidal intent. Of 671 patients with complete data, ratio of number of patients with hepatotoxicity due to rodenticide to paracetamol overdose was 450:6 (i.e. 75:1). The 451 rodenticidal hepatotoxicity patients (255 males, 75% were 15-34 years old) underwent conservative management (n=396), plasma exchange (n=54) and plasma exchange followed by liver transplant (n=1); 159 patients (35%) had poor outcome (131 died, 28 discharged in moribund state). Based on our observations, we estimate a case burden of 1584 rodenticidal hepatotoxicity patients (95% CI: 265-6119) with poor outcome in 554 patients in Tamil Nadu from January 2019 to June 2019. Population attributable risk for rodenticide as cause of hepatotoxicity was 22.7%.
Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu. Most patients were young and one-third had poor outcome. Public health interventions are needed to address this.
尽管印度有报道称杀鼠剂具有肝毒性，但尚无系统研究评估其严重程度。本研究旨在评估摄入杀鼠剂是否是印度泰米尔纳德邦发生急性肝毒性的危险因素。
我们回顾性分析了 2019 年 1 月 1 日至 2019 年 6 月 30 日期间，泰米尔纳德邦 6 个地区的 15 家医院因摄入肝毒素或潜在肝毒性药物过量导致的急性肝毒性。研究排除标准为特发性药物性肝损伤和慢性肝病。
702 例患者中，685 例有摄入杀鼠剂的病史；其余 10 例患者的肝毒性是由对乙酰氨基酚过量引起的，7 例患者的肝毒性是由其他药物引起的；97%的患者有自杀倾向。在 671 例有完整数据的患者中，因杀鼠剂引起肝毒性的患者与对乙酰氨基酚过量的患者的比例为 450:6（即 75:1）。451 例杀鼠剂肝毒性患者（255 名男性，75%为 15-34 岁）接受了保守治疗（n=396）、血浆置换（n=54）和血浆置换后肝移植（n=1）；159 例（35%）患者预后不良（131 例死亡，28 例在垂危状态下出院）。根据我们的观察，我们估计 2019 年 1 月至 6 月期间，泰米尔纳德邦因杀鼠剂引起肝毒性的病例负担为 1584 例（95%CI：265-6119），其中 554 例患者预后不良。杀鼠剂作为肝毒性病因的人群归因风险为 22.7%。
摄入杀鼠剂是泰米尔纳德邦急性肝毒性的一个重要原因。大多数患者年龄较轻，三分之一的患者预后不良。需要采取公共卫生干预措施来解决这个问题。
