Predicting Outcome in Organophosphorus Poisoning Using RBC Cholinesterase and Serum Cholinesterase Values: A Hospital-based Longitudinal Study

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Saswati Kar, Nihar Ranjan Mohanty, Bhagyashree Panda, Roma Rattan, Anurag Choudhury, Suchismita Panda, Pramod Kumar Rout, Bhaktabandhu Das, Biswaranjan Prusty, Pravat Kumar Thatoi
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Abstract

Abstract Background Organophosphorus (OP) poisoning is a leading cause of mortality due to self-harm in Asian countries, including India. Red blood cell cholinesterase (RBC-ChE) and serum cholinesterase (serum-ChE) levels are used for predicting outcomes. There is a paucity of literature studying the RBC-ChE levels in OP poisoning and comparing it with the serum-ChE levels. Methods This is a longitudinal study assessing the outcome in OP poisoning patients using the RBC-ChE and serum-ChE levels. Both enzyme levels are compared and correlated for adult patients presenting within 24 hours of consumption of the OP compound. Sensitivity and specificity are measured. Results Of the 99 OP poisoning patients included, 20 patients did not survive, and 23 patients required ventilatory support. At admission, RBC-ChE (median, interquartile range [IQR]) was significantly different between survivors (45.2 [30.5–60] U/g Hb) and nonsurvivors (6.3 [4.2–13.4] U/g Hb), while serum-ChE (median, IQR) was not statistically different (p = 0.061) between survivors (350 [247–670]) and nonsurvivors (290 [182–415.8]). Similarly, RBC-ChE was significantly different between patients requiring a ventilator and those not requiring a ventilator (6.8 vs. 44.2 U/g Hb), whereas the serum-ChE values measured on admission were not significantly different for patients requiring a ventilator versus those not requiring a ventilator (290 vs. 348 U/L; p = 0.119). At the cutoff of 20 U/g Hb, RBC-ChE had 90.5% sensitivity and 91% specificity in predicting mortality. Kaplan–Meier survival showed the probability of survival decreased to nearly 50% if the time to reach the hospital was ≥4 hours. Conclusion RBC-ChE was superior in predicting outcomes in OP poisoning patients compared with serum-ChE measured on the day of admission.
利用红细胞胆碱酯酶和血清胆碱酯酶值预测有机磷中毒的预后:一项基于医院的纵向研究
背景有机磷(OP)中毒是包括印度在内的亚洲国家自残致死的主要原因。红细胞胆碱酯酶(RBC-ChE)和血清胆碱酯酶(血清- che)水平用于预测预后。目前研究OP中毒患者红细胞- che水平并与血清che水平比较的文献较少。方法采用红细胞- che和血清che水平对OP中毒患者的预后进行纵向研究。对服用OP化合物24小时内出现的成年患者的两种酶水平进行了比较和相关性研究。测量敏感性和特异性。结果99例OP中毒患者中,20例死亡,23例需要呼吸支持。入院时,幸存者(45.2 [30.5-60]U/g Hb)和非幸存者(6.3 [4.2-13.4]U/g Hb)之间的RBC-ChE(中位数,四分位数间距[IQR])有显著差异,而幸存者(350[247-670])和非幸存者(290[182-415.8])之间的血清che(中位数,IQR)无统计学差异(p = 0.061)。同样,需要呼吸机和不需要呼吸机的患者之间的RBC-ChE有显著差异(6.8 vs 44.2 U/g Hb),而入院时需要呼吸机和不需要呼吸机的患者的血清che值无显著差异(290 vs 348 U/L;P = 0.119)。在20 U/g Hb的临界值下,RBC-ChE预测死亡率的敏感性为90.5%,特异性为91%。Kaplan-Meier生存率显示,如果到达医院的时间≥4小时,生存概率下降到近50%。结论与入院当日测定的血清che相比,RBC-ChE对OP中毒患者预后的预测效果更好。
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来源期刊
Journal of Laboratory Physicians
Journal of Laboratory Physicians MEDICINE, GENERAL & INTERNAL-
自引率
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发文量
99
审稿时长
31 weeks
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