Early hemoperfusion may improve survival of severely paraquat-poisoned patients.
BACKGROUND: Thousands of paraquat (PQ)-poisoned patients continue to die, particularly in developing countries. Although animal studies indicate that hemoperfusion (HP) within 2-4 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown. METHODS: We analyz...
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doaj-1efa8f50f88c47a3a07945bfe2a46cfe2020-11-25T01:32:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-01710e4839710.1371/journal.pone.0048397Early hemoperfusion may improve survival of severely paraquat-poisoned patients.Ching-Wei HsuJa-Liang LinDan-Tzu Lin-TanKuan-Hsing ChenTzung-Hai YenMai-Szu WuShih-Chieh LinBACKGROUND: Thousands of paraquat (PQ)-poisoned patients continue to die, particularly in developing countries. Although animal studies indicate that hemoperfusion (HP) within 2-4 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown. METHODS: We analyzed the records of all PQ-poisoned patients admitted to 2 hospitals between 2000 and 2009. Patients were grouped according to early or late HP and high-dose (oral cyclophosphamide [CP] and intravenous dexamethasone [DX]) or repeated pulse (intravenous methylprednisolone [MP] and CP, followed by DX and repeated MP and/or CP) PQ therapy. Early HP was defined as HP <4 h, and late HP, as HP ≥ 4 h after PQ ingestion. We evaluated the associations between HP <4 h, <5 h, <6 h, and <7 h after PQ ingestion and the outcomes. Demographic, clinical, laboratory, and mortality data were analyzed. RESULTS: The study included 207 severely PQ-poisoned patients. Forward stepwise multivariate Cox hazard regression analysis showed that early HP <4 h (hazard ratio [HR] = 0.38, 95% confidence interval (CI) 0.16-0.86; P = 0.020) or HP <5 h (HR = 0.60, 95% CI: 0.39-0.92; P = 0.019) significantly decreased the mortality risk. Further analysis showed that early HP reduced the mortality risk only in patients treated with repeated pulse therapy (n = 136), but not high-dose therapy (n = 71). Forward stepwise multivariate Cox hazard regression analysis showed that HP <4.0 h (HR = 0.19, 95% CI: 0.05-0.79; P = 0.022) or <5.0 h (HR = 0.49, 95% CI: 0.24-0.98; P = 0.043) after PQ ingestion significantly decreased the mortality risk in repeated pulse therapy patients, after adjustment for relevant variables. CONCLUSION: The results showed that early HP after PQ exposure might be effective in reducing mortality in severely poisoned patients, particularly in those treated with repeated pulse therapy.http://europepmc.org/articles/PMC3483292?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ching-Wei Hsu Ja-Liang Lin Dan-Tzu Lin-Tan Kuan-Hsing Chen Tzung-Hai Yen Mai-Szu Wu Shih-Chieh Lin |
spellingShingle |
Ching-Wei Hsu Ja-Liang Lin Dan-Tzu Lin-Tan Kuan-Hsing Chen Tzung-Hai Yen Mai-Szu Wu Shih-Chieh Lin Early hemoperfusion may improve survival of severely paraquat-poisoned patients. PLoS ONE |
author_facet |
Ching-Wei Hsu Ja-Liang Lin Dan-Tzu Lin-Tan Kuan-Hsing Chen Tzung-Hai Yen Mai-Szu Wu Shih-Chieh Lin |
author_sort |
Ching-Wei Hsu |
title |
Early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
title_short |
Early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
title_full |
Early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
title_fullStr |
Early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
title_full_unstemmed |
Early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
title_sort |
early hemoperfusion may improve survival of severely paraquat-poisoned patients. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
BACKGROUND: Thousands of paraquat (PQ)-poisoned patients continue to die, particularly in developing countries. Although animal studies indicate that hemoperfusion (HP) within 2-4 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown. METHODS: We analyzed the records of all PQ-poisoned patients admitted to 2 hospitals between 2000 and 2009. Patients were grouped according to early or late HP and high-dose (oral cyclophosphamide [CP] and intravenous dexamethasone [DX]) or repeated pulse (intravenous methylprednisolone [MP] and CP, followed by DX and repeated MP and/or CP) PQ therapy. Early HP was defined as HP <4 h, and late HP, as HP ≥ 4 h after PQ ingestion. We evaluated the associations between HP <4 h, <5 h, <6 h, and <7 h after PQ ingestion and the outcomes. Demographic, clinical, laboratory, and mortality data were analyzed. RESULTS: The study included 207 severely PQ-poisoned patients. Forward stepwise multivariate Cox hazard regression analysis showed that early HP <4 h (hazard ratio [HR] = 0.38, 95% confidence interval (CI) 0.16-0.86; P = 0.020) or HP <5 h (HR = 0.60, 95% CI: 0.39-0.92; P = 0.019) significantly decreased the mortality risk. Further analysis showed that early HP reduced the mortality risk only in patients treated with repeated pulse therapy (n = 136), but not high-dose therapy (n = 71). Forward stepwise multivariate Cox hazard regression analysis showed that HP <4.0 h (HR = 0.19, 95% CI: 0.05-0.79; P = 0.022) or <5.0 h (HR = 0.49, 95% CI: 0.24-0.98; P = 0.043) after PQ ingestion significantly decreased the mortality risk in repeated pulse therapy patients, after adjustment for relevant variables. CONCLUSION: The results showed that early HP after PQ exposure might be effective in reducing mortality in severely poisoned patients, particularly in those treated with repeated pulse therapy. |
url |
http://europepmc.org/articles/PMC3483292?pdf=render |
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