Efficacy of intravenous N acetylcysteine as an adjuvant therapy in the treatment of acute aluminum phosphide Poisoning: a systematic review and meta-analysis.
{"title":"Efficacy of intravenous N acetylcysteine as an adjuvant therapy in the treatment of acute aluminum phosphide Poisoning: a systematic review and meta-analysis.","authors":"Heba Othman Shaker, Omar El Sayed Rageh, Maged Alnajar, Nesreen Fares Alshamaly, Walaa Abdelfattah Abdelmaged, Mohamed Abd-ElGawad","doi":"10.1186/s40360-023-00699-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Aluminum phosphide toxicity is a serious problem in many countries. Unfortunately, there is no specific antidote. N-acetylcysteine has been used in some studies as adjuvant therapy depending on to its antioxidant properties. We hypothesized that IV N-acetylcysteine is effective in reducing mortality rate compared to supportive treatment alone.</p><p><strong>Methods: </strong>We searched in PubMed, Scopus, Web of Science, and Cochrane Library databases. We only included randomized controlled trials that assessed the efficacy of IV N-acetylcysteine and supportive treatment versus supportive treatment alone in acute aluminum phosphide poisoning. Four investigators independently screened the studies' results and designed the data extraction sheet. The primary and secondary outcomes were mortality and the need for mechanical ventilation rates. Random effects estimators with weights were used to result in the pooled risk ratios.</p><p><strong>Results: </strong>We included four randomized controlled trials with 177 patients. 91 patients were distributed in N-acetylcysteine group and 86 patients in the control group. Mortality rates in N-acetylcysteine group and in the control group were 43.95% 66.27% respectively. There was a statistically significant reduction in mortality rate after leave out test (pooled risk ratio, 0.5; 95% confidence interval, 0.32-0.77). Regarding the need for mechanical ventilation, it was measured only in three RCTs. It was assessed in 67 patients in N-acetylcysteine group and 60 patients in the control group. 24 patients were ventilated in N-acetylcysteine group (35.8%) and 29 patients in the control group (48.3%). But it was statistically nonsignificant (pooled risk ratio, 0.71; 95% confidence interval, 0.48-1.04).</p><p><strong>Conclusion: </strong>Our meta-analysis revealed that IV N-acetylcysteine may be effective in reducing mortality of severe aluminum phosphide poisoning cases.</p><p><strong>Trial registration: </strong>Registration number in Prospero CRD42022375344 on 25 NOVEMBER 2022, retrospectively registered.</p>","PeriodicalId":9023,"journal":{"name":"BMC Pharmacology & Toxicology","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625249/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Pharmacology & Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40360-023-00699-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Aluminum phosphide toxicity is a serious problem in many countries. Unfortunately, there is no specific antidote. N-acetylcysteine has been used in some studies as adjuvant therapy depending on to its antioxidant properties. We hypothesized that IV N-acetylcysteine is effective in reducing mortality rate compared to supportive treatment alone.
Methods: We searched in PubMed, Scopus, Web of Science, and Cochrane Library databases. We only included randomized controlled trials that assessed the efficacy of IV N-acetylcysteine and supportive treatment versus supportive treatment alone in acute aluminum phosphide poisoning. Four investigators independently screened the studies' results and designed the data extraction sheet. The primary and secondary outcomes were mortality and the need for mechanical ventilation rates. Random effects estimators with weights were used to result in the pooled risk ratios.
Results: We included four randomized controlled trials with 177 patients. 91 patients were distributed in N-acetylcysteine group and 86 patients in the control group. Mortality rates in N-acetylcysteine group and in the control group were 43.95% 66.27% respectively. There was a statistically significant reduction in mortality rate after leave out test (pooled risk ratio, 0.5; 95% confidence interval, 0.32-0.77). Regarding the need for mechanical ventilation, it was measured only in three RCTs. It was assessed in 67 patients in N-acetylcysteine group and 60 patients in the control group. 24 patients were ventilated in N-acetylcysteine group (35.8%) and 29 patients in the control group (48.3%). But it was statistically nonsignificant (pooled risk ratio, 0.71; 95% confidence interval, 0.48-1.04).
Conclusion: Our meta-analysis revealed that IV N-acetylcysteine may be effective in reducing mortality of severe aluminum phosphide poisoning cases.
Trial registration: Registration number in Prospero CRD42022375344 on 25 NOVEMBER 2022, retrospectively registered.
背景：磷化铝的毒性在许多国家都是一个严重的问题。不幸的是，没有特效药。N-乙酰半胱氨酸由于其抗氧化特性，在一些研究中被用作辅助治疗。我们假设静脉注射N-乙酰半胱氨酸与单独的支持性治疗相比能有效降低死亡率。方法：检索PubMed、Scopus、Web of Science和Cochrane Library数据库。我们只纳入了随机对照试验，这些试验评估了静脉注射N-乙酰半胱氨酸和支持性治疗与单独支持性治疗急性磷化铝中毒的疗效。四名研究人员对研究结果进行了独立筛选，并设计了数据提取表。主要和次要结果是死亡率和需要机械通气率。使用具有权重的随机效应估计量来得出合并风险比。结果：我们纳入了四项随机对照试验，共177名患者。N-乙酰半胱氨酸组91例，对照组86例。N-乙酰半胱氨酸组和对照组的死亡率分别为43.95%和66.27%。遗漏试验后死亡率有统计学意义的降低（合并风险比为0.5；95%置信区间为0.32-0.77）。关于机械通气的必要性，仅在三项随机对照试验中进行了测量。在N-乙酰半胱氨酸组的67名患者和对照组的60名患者中进行了评估。N-乙酰半胱氨酸组24例（35.8%）和对照组29例（48.3%）进行了通气。但这在统计学上并不显著（合并风险比为0.71；95%置信区间为0.48-1.04）。结论：我们的荟萃分析显示，静脉注射N-乙酰半胱氨酸可能有效降低严重磷化铝中毒病例的死亡率。试验注册：2022年11月25日在Prospero CRD42022375344中的注册号，追溯注册。
期刊介绍：
BMC Pharmacology and Toxicology is an open access, peer-reviewed journal that considers articles on all aspects of chemically defined therapeutic and toxic agents. The journal welcomes submissions from all fields of experimental and clinical pharmacology including clinical trials and toxicology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
