Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients
Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients
复制标题
首次血液灌流后的血浆浓度对中度急性百草枯中毒患者具有较高的预测价值
DOI：
10.1097/ftd.0000000000000889
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发表时间：
2021-12-01
影响因子：
2.5
通讯作者：
Lu，Zhongqiu
中科院分区：
文献类型：
--
作者：
Tang，Yahui;Chen，Hui;Lu，Zhongqiu
背景：百草枯（Paraquat，PQ）对人和动物有很强的毒性，目前尚无有效的临床解毒剂。血液灌流（HP）治疗PQ中毒的有效性仍存在争议。目的：探讨急性PQ中毒患者预后预测的新方法，为制定更好的血液净化治疗策略提供帮助。方法：收集经接触中毒患者的临床资料，采用高效液相色谱法诊断为PQ中毒。样本由温州医科大学附属第一医院急诊重症监护室于2012年1月至2016年11月采集。根据预后将患者分为生存组和死亡组。比较两组患者入院时PQ初始浓度、首次HP后PQ浓度、首次血液灌流使用HP盒数、HP是否联合连续性肾脏替代治疗、并发器官损伤例数等临床指标的差异。此外，使用多变量逻辑回归模型和受试者工作特征曲线分析数据。结果：共纳入急性PQ中毒患者128例。患者入院时的中位血浆PQ浓度为21和834 ng/mL（范围：50- 1，099，118 ng/mL）。多因素Logistic回归分析显示，PQ初始浓度和首次灌流后PQ浓度是急性PQ中毒患者死亡的独立危险因素。存活组首次HP后PQ浓度< 516 ng/mL，主要分布在100 ng/mL左右。结论：急性PQ中毒患者入院时血PQ浓度和首次HP后血PQ浓度是急性PQ中毒患者死亡的危险因素。此外，第一次HP后的PQ浓度对死亡具有较高的预测值。当入院后初始血浆PQ浓度在50 ~ 5000 ng/mL范围内时，HP治疗后血浆PQ浓度迅速降低可改善急性PQ中毒患者的预后。
Background:Paraquat (PQ) is very poisonous to humans and animals and there is no effective clinical antidote. The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies.Methods:The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by high-performance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed.Results:Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50–1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was< 516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was< 516 ng/mL in the death group was only 19%.Conclusions:The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.