Comparison of severity index and plasma paraquat concentration for predicting survival after paraquat poisoning: A meta-analysis

Zong Xun Cao, Yong Zhao, Jie Gao, Shun Yi Feng, Cheng Pu Wu, Yan Zhao Zhai, Meng Zhang, Shen Nie, Yong Li, Zong Xun Cao, Yong Zhao, Jie Gao, Shun Yi Feng, Cheng Pu Wu, Yan Zhao Zhai, Meng Zhang, Shen Nie, Yong Li

Abstract

Background: Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning.

Methods: We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis.

Results: Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95% CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis.

Conclusion: Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart for study selection.
Figure 2
Figure 2
Risk of bias and applicability concerns.
Figure 3
Figure 3
Forest plot of severity index (A) and plasma PQ concentration (B) for mortality. PQ = paraquat.
Figure 4
Figure 4
Summary receiver-operating-characteristic curves for estimating the testing accuracy of severity index (A) and plasma PQ concentration (B) for mortality. PQ = paraquat.
Figure 5
Figure 5
Sensitivity analysis of severity index (A) and plasma PQ concentration (B) for mortality. PQ = paraquat.
Figure 6
Figure 6
Funnel plot of the publication bias test for severity index ((A) Begg test and (B) Egger test) and plasma PQ concentration ((C) Begg test and (D) Egger test).

References

    1. Suntres ZE. Role of antioxidants in paraquat toxicity. Toxicology 2002;180:65–77.
    1. Gao J, Cao Z, Feng S, et al. Patients with mild paraquat poisoning treated with prolonged low-dose methylprednisolone have better lung function: a retrospective analysis. Medicine (Baltimore) 2018;97:e0430.
    1. Rodrigues da Silva M, Schapochnik A, Peres Leal M, et al. Beneficial effects of ascorbic acid to treat lung fibrosis induced by paraquat. PLoS One 2018;13:e0205535.
    1. Sun S, Jiang Y, Wang R, et al. Treatment of paraquat-induced lungbinjury with an anti-C5a antibody: potential clinical application. Crit Care Med 2018;46:e419–25.
    1. Elenga N, Merlin C, Le Guern R, et al. Clinical features and prognosis of paraquat poisoning in French Guiana: a review of 62 cases. Medicine (Baltimore) 2018;97:e9621.
    1. Wu WP, Lai MN, Lin CH, et al. Addition of immunosuppressive treatment to hemoperfusion is associated with improved survival after paraquat poisoning: a nationwide study. PLoS One 2014;9:e87568.
    1. Tan JT, Letchuman Ramanathan G, Choy MP, et al. Paraquat poisoning: experience in hospital taiping (year 2008–october 2011). Med J Malaysia 2013;68:384–8.
    1. Chen XB, Mo J, Xu T, et al. Comparison of prognostic indicators of acute paraquat poisoning. Chin Gen Pract 2015;18:2089–91.
    1. Du Y, Mou Y. Predictive value of 3 methods in severity evaluation and prognosis of acute paraquat poisoning. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2013;38:737–42.
    1. Huang NC, Hung YM, Lin SL, et al. Further evidence of the usefulness of Acute Physiology and Chronic Health Evaluation II scoring system in acute paraquat poisoning. Clin Toxicol (Phila) 2006;44:99–102.
    1. Min YG, Ahn JH, Chan YC, et al. Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department. Clin Toxicol (Phila) 2011;49:840–5.
    1. Niu Ld, Zhang JX, Hao TQ, et al. The value of assessing the severity and prognosis of plasma paraquat concentration and paraquat poisoning severity index at admission in patients with poisoning. PractHosp Clin J 2018;15:87–9.
    1. Sun L, Yan P, Liu Y, et al. Analysis of prognostic value of initial serum paraquat concentration in patients with paraquat poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015;33:697–700.
    1. Zhou DC, Zhang H, Luo ZM, et al. Prognostic value of hematological parameters in patients with paraquat poisoning. Sci Rep 2016;6:36235.
    1. McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 2018;319:388–96.
    1. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Chin Gen Pract 2011;155:529–36.
    1. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.
    1. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34.
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–101.
    1. Feng S, Gao J, Li Y. A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning. PLoS One 2018;13:e0201200.
    1. Senarathna L, Eddleston M, Wilks MF, et al. Prediction of outcome after paraquat poisoning by measurement of the plasma paraquat concentration. QJM 2009;102:251–9.
    1. Gil HW, Kang MS, Yang JO, et al. Association between plasma paraquat level and outcome of paraquat poisoning in 375 paraquat poisoning patients. Clin Toxicol (Phila) 2008;46:515–8.
    1. Proudfoot AT, Stewart MS, Levitt T, et al. Paraquat poisoning: significance of plasma-paraquat concentrations. Lancet 1979;2:330–2.
    1. Seok S, Kim YH, Gil HW, et al. The time between paraquat ingestion and a negative dithionite urine test in an independent risk factor for death and organ failure in acute paraquat intoxication. J Korean Med Sci 2012;27:993–8.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever