Prognostic Predictor of Acute Paraquat Intoxication Who Survived the Initial Injury

Background: Paraquat intoxication has high mortality rate. Initial clinical parameters correlating with prognosis such as plasma and urine paraquat levels, serum creatinine levels and critical score were reported. It is still unknown what are the prognostic factors in patients who survived in initial injury. Aim: The aim of study was to define the late prognostic factors in patients who survived an initial multi-organ injury. Materials and Methods: Sixty-eight patients with paraquat poisoning admitted to our hospital from 1990 to 2005 were enrolled. The patients were further divided into survival and mortality groups according to the outcomes. The clinical courses including laboratory data, treatments and outcomes were reviewed retrospectively. Results: The overall mortality rate was 83.8%. The initial urine and plasma paraquat level of mortality patients were 44.90±12.58 ppm and 14.25±8.16 ppm respectively. The initial urine and plasma paraquat level of survival patients were 30.45±22.63 ppm and 0.85±1.26 ppm respectively. The initial urine and plasma paraquat levels of the mortality group were higher than the survival group. The creatinine level on the first day of survival and mortality patients were 0.84±0.26 mg/dl and 2.18±1.62 mg/dl respectively. Initial serum creatinine of the mortality group was higher significantly (P=0.012). The clinical parameters including arterial pressure of oxygen (PaO2), creatinine, alanine aminotransferase and total bilirubin reached the peak/lowest level in the third day after intoxication. The serum creatinine on the third day after poisoning of survival and late mortality patients were 1.28±0.46 mg/dl and 4.51±2.56 mg/dl. The serum creatinine at the third day after poisoning was significantly different between the survival and mortality patients who survived the first two days (P=0.013). No statistical difference in other clinical parameters and treatments was found between the survival and mortality groups. Conclusions: Initial high urine and plasma paraquat level was associated with high mortality. Serum creatinine on the third day after intoxication was the sole prognostic factor in our patients who survived the first two days.