Significance of early measurement of plasma-paraquat concentrations in patients with acute paraquat poisoning

Objective To explore the significance of early measurement of plasma-paraquat concentrations in assessing the severity of liver and kidney injury and predicting the outcome in patients with acute paraquat poisoning(APP).Methods The case reports of patients with APP in Department of Gastroenterology,Affiliated Hospital of Academy of Military Medical Science from June 2006 to June 2012were collected and retrospectively analyzed.The inclusion criteria were as follows:the patients were orally poisoned,without undergoing infusion and hemoperfusion treatment,the time from poisoning to admission ≤6 h.According to the plasma-paraquat concentrations measured on admission,the patients were divided into the low-concentration group(0.5 mg/L),moderate-concentration group(0.5-2.0 mg/L),and highconcentration group( 2.0 mg/L).The highest values of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin,blood urea,and serum creatinine levels detected during hospitalization in the 3 groups were compared.The mortalities in the 3 groups were calculated and compared.Results Data of a total of 87 patients were collected according to the inclusion criteria.Of them,48 patients were male and 39 were female with age of 9-76(30 ±14) years.There were 31,27,and29 patients in the low-,moderate-,and high-concentration groups,respectively.The differences in gender,age distribution,and the time from poisoning to admission among the 3 groups were not statistically significant(P0.05).The median(Q1,Q3) of the highest values of AST,ALT,total bilirubin,blood urea,and serum creatinine levels in the 3 groups were 39(18,87),126(92,249),and 345(108,666)U/L;29(25,37),120(57,222),and 233(106,361) U/L;24(18,33),31(22,52),and 65(39,86)μmol/L;77(59,136),243(134,421),and 295(248,489) μmol/L;8(5,11),15(13,21),and24(19,27) mmol/L;respectively.The mortalities in the 3 groups were 3.2%(1/31),44.4%(12/27),and 86.2%(25/29),respectively.Pairwise comparisons among the 3 groups were performed and the differencesin all items mentioned above were significant statistically(P0.05 or P0.01).Conclusion Plasma-paraquat concentrations measured in the early stage of paraquat poisoning could be used to assess the severity of liver and kidney injury and predict the outcome in patients with APP.