Department of Clinical Toxicology, School of Medicine; Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Medical Practitioner, Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Pharmacol Toxicol. 2022 Sep 6;23(1):67. doi: 10.1186/s40360-022-00609-y.
Paraquat is a non-selective herbicide that causes severe tissue damage in various organs including the liver and kidney. The aim of this study was to determine the trend of the liver and kidney injury in patients with paraquat poisoning.
This retrospective cross-sectional study was performed at the Khorshid Hospital referral poisoning emergency center. The medical records of all patients with acute paraquat poisoning admitted from March 2017 to October 2020 were reviewed. Demographic factors, liver and kidney function tests and outcomes were recorded. Patients were divided into two groups based on the outcome of mortality (death or survived). The two groups were compared in terms of changes in creatinine and liver enzymes during hospitalization.
A significant difference in mean creatinine levels between the two groups was observed from the third day after admission. The peak median Cr was 3.5 mg/dl for deceased patients in day 6 and 1.47 mg/dl for survived patients on 4th day. Minor elevations of ALT and AST were present in those who died. Logistic regression analysis shows patients who had level of creatinine higher than normal from the 2nd to 6th day post overdose, the risk of mortality was 4.83 to 7.44 times more than patients with normal creatinine level. The mean (SD) area under the curve for outcome prediction was reported to be excellent for creatinine on the 8th day post overdose (85.7 ± 13.2). Creatinine was higher than 2 on the 8th day post ingestion and had a sensitivity 100% and specificity 85.7% for mortality prediction (P value, 0.05).
The risk of mortality secondary to paraquat ingestion was highly associated with a rise in creatinine. Minor elevations of ALT and AST were also present in those who died. The creatinine concentration on different days post overdose can be helpful in predicting the severity of poisoning especially when the serum paraquat levels are not available.
百草枯是一种非选择性除草剂，会导致包括肝、肾在内的多种器官严重组织损伤。本研究旨在确定百草枯中毒患者肝肾功能损伤的趋势。
本回顾性横断面研究在 Khorshid 医院转诊中毒急救中心进行。回顾性分析 2017 年 3 月至 2020 年 10 月期间所有急性百草枯中毒患者的病历。记录人口统计学因素、肝肾功能检查和结局。根据死亡率（死亡或存活）将患者分为两组。比较两组患者住院期间肌酐和肝酶的变化。
入院后第 3 天，两组患者的平均肌酐水平差异有统计学意义。死亡组患者第 6 天的峰值中位数 Cr 为 3.5mg/dl，存活组患者第 4 天为 1.47mg/dl。死亡患者的 ALT 和 AST 略有升高。Logistic 回归分析显示，入院后第 2 至 6 天肌酐水平高于正常值的患者，其死亡率是肌酐水平正常患者的 4.83 至 7.44 倍。入院后第 8 天，用于预测结局的肌酐曲线下面积（AUC）均值（SD）报道为非常优秀（85.7±13.2）。入院后第 8 天肌酐值>2，其预测死亡率的灵敏度为 100%，特异性为 85.7%（P 值，0.05）。
百草枯摄入后死亡率与肌酐升高高度相关。死亡患者的 ALT 和 AST 也略有升高。入院后不同时间点的肌酐浓度有助于预测中毒的严重程度，特别是在无法检测血清百草枯水平时。
