چکیده (انگلیسی):

Paraquat poisoning resulted in multiorgan failure and is associated with high mortality. We
audited 83 historical cases of paraquat poisoning in past 2 years treated with conventional
decontamination and supportive treatment, followed by enrolling 85 patients over a 2 year
period into additional immunosuppression with intravenous (i.v.) methylprednisolone and
i.v. cyclophosphamide.
Our results showed that age, poor renal function and leucocytosis are the main predictors
of fatal outcome. Immunosuppression regime rendered higher survival (6 out of 17 patients
(35.3%)) versus historical control (1 out of 18 patients (5.6%)) (p = 0.041) in the cohort with
admission eGFR < 50 ml/min/1.73 m2 and WBC count > 11,000/L.
In contrast, there was no difference in survival with immunosuppression regime (38
out of 64 patients (59.4%)) compared to historical control (30 out of 52 patients (57.7%))
(p = 0.885) in those with eGFR > 50 ml/min/1.73 m2 or WBC < 11,000/L at presentation.
Multivariable logistic regression showed survival probability = exp(logit)/(1 + exp(logit)),
in which logit = 13.962
−
(0.233
×
ln(age (year)))
−
(1.344
×
ln(creatinine (mol/L)))
−
(1.602
×
ln(rise in creatinine (mol/day))) – (0.614
×
ln(WBC (,000/L))) + (2.021
×
immunosuppression) and immunosuppression = 1 if given and 0 if not. Immunosuppression
therapy yielded odds ratio of 0.132 (95% confidential interval: 0.029–0.603,
p = 0.009).
In conclusion, immunosuppression therapy with intravenous methylprednisolone and
cyclophosphamide may counteract immune mediated inflammation after paraquat poisoning
and improve survival of patients with admission eGFR < 50 ml/min/1.73 m2 and WBC
count > 11,000/L.