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Predictors of Severity and Survival in Acute Cases of Organophosphorous Poisoning at Zagazig University Hospitals: Prospective Cohort Study


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1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Elsharquia – 44511, Egypt
     

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Organophosphorous Insecticides (OPIs) have been profusely used and toxicity by them are common. Scoring systems are used as predictors of survival in severely ill patients. OPIs toxicity is associated with multiple biochemical abnormalities like changes in serum lactate. The aim of this study was evaluation the role of Acute physiology and chronic health evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores, acetyl cholinesterase (AChE), and lactate enzymes in assessing severity, outcome and complications in acutely OPIs poisoned patients. This prospective cohort study was carried out on 36 OPIs poisoned patients admitted to Zagazig University Hospitals in seven months’ period from the beginnings of May 2019 till the end of November 2019. The Peradeniya Organophosphorus Poisoning (POP), APACHE II and SOFA scores were calculated on the first day of admission. Serum lactate, and AChE enzymes were measured on admission and after 24 h. The cases were aged from 3 to 66 years old. As result of the study: APACHE II and SOFA scores were predictors of severity. The decrease in AChE level was correlated with the severity and complications but it was not predictor of them. Lactate was predictor of outcome and complications. Thus, APACHE II and SOFA scores can have used as predictors of severity. Also, lactate can be used as a predictor of outcome and complications.

Keywords

Acetyl Cholinesterase, Acute Physiology and Chronic Health Evaluation II (APACHE II), Lactate, Organophosphorous Insecticides, Sequential Organ Failure Assessment (SOFA) Score.
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  • King AM, Aaron CK. Organophosphate and Carbamate Poisoning. Emerg Med Clin. 2015; 33(1):133– 51. https://doi.org/10.1016/j.emc.2014.09.010. PMid:25455666
  • Vijaya S, Sudhakar Y, Venkateswarlu B. Current review on organophosphorus poisoning. Archieves of Applied Science and Research. 2010; 2(4):199–215.
  • Kim YH, Yeo JH, Kang MJ, et al. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients. J Kor Med Sci. 2013; 28(12):1822–6. https://doi.org/10.3346/jkms.2013.28.12.1822. PM id:24339715. PMCid:PMC3857381
  • Carey JL, Dunn C, Gaspari RJ. Central respiratory failure during acute organophosphate poisoning. Respiratory Physiology and Neurobiology. 2013; 189(2):403–10. https://doi.org/10.1016/j.resp.2013.07.022. PMid:23933009
  • Arwa AE-S, Eman E-SK, Reem A. Human kidney injury molecule-1 and interleukin-18 as predictive markers of nephrotoxicity in acute organophosphorus poisoned patients in Zagazig University hospitals. J Toxicol Environ Health Sci. 2018; 10(5):34–43. https://doi.org/10.5897/JTEHS2018.0418
  • Lee F-Y, Chen W-K, Lin C-L, et al. Organophosphate poisoning and subsequent acute kidney injury risk: a nationwide population-based cohort study. Medicine. 2015; 94(47). https://doi.org/10.1097/MD.0000000000002107. PMid:26632728. PMCid:PM C5058997
  • Tang W, Ruan F, Chen Q, et al. Independent prognostic factors for acute organophosphorus pesticide poisoning. Respiratory Care. 2016; 61(7):965–70. https://doi.org/10.4187/respcare.04514. PMid:27048625
  • Ye M, Beach J FAU - Martin WJ, FAU MJW, Senthilselvan A. Occupational pesticide exposures and respiratory health. International Journal of Environmental Research and Public Health. 1009; 10(12):6442–71. https://doi.org/10.3390/ijerph10126442. PMid:242878 63. PMCid:PMC3881124
  • Williams L, Gannon J. Use of the SOFA score in pandemic influenza - A prospective study. Media, War and Conflict. 2009; 10(3):179–82. https://doi.org/10.1177/175114370901000305
  • Ibrahim MA, El Masry MK, Moustafa AA, Hagras AM, Ali NM. Comparison of the accuracy of two scoring systems in predicting the outcome of organophosphate intoxicated patients admitted to Intensive Care Unit (ICU). Egypt J Forensic Sci. 2011; 1:41–7. https://doi.org/10.1016/j.ejfs.2011.04.013
  • Sumathi M, Kumar S, Shashidhar K, Takkalaki N. Prognostic significance of various biochemical parameters in acute organophosphorus poisoning. Toxicol Int. 2014; 21(2):167–71. https://doi.org/10.41 03/0971-6580.139800. PMid:25253926. PMCid:PMC 4170558
  • Reade MC, Davies SR, Morley PT, Dennett J, Jacobs IC, Council AR. Management of cyanide poisoning. Emergency Medicine Australasia. 2012; 24(3):225–38. https://doi.org/10.1111/j.1742-6723.2012.01538.x. PMid:22672162
  • Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. In: Mayo Clinic Proceedings. 2013; 88:1127–40. https://doi. org/10.1016/j.mayocp.2013.06.012. PMid:24079682. PMCid:PMC3975915
  • Dominiczak MH, Szczepańska-Konkel M. Regulation of hydrogen ion concentration (acid-base balance). Medical Biochemistry E-Book; 2014.
  • Ellman GL, Courtney KD, Andres Jr V, Featherstone RM. A new and rapid colorimetric determination of acetylcholinesterase activity. Biochem Pharmacol. 1961; 7(2):88–95. https://doi.org/10.1016/0006-2952 (61)90145-9
  • Alejo-González K, Hanson-Viana E, Vazquez-Duhalt R. Enzymatic detoxification of organophosphorus pesticides and related toxicants 有機リン系殺虫剤 よび関連毒物の酵素的無毒化. J Pestic Sci. 2018; 43(1):1–9. https://doi.org/10.1584/jpestics.D17-078. PMid:30363124. PMCid:PMC6140661
  • El-Naggar AER, Abdalla MS, El-Sebaey AS, Badawy SM. Clinical findings and cholinesterase levels in children of organophosphates and carbamates poisoning. Eur J Pediatr. 2009; 168(8):951–6. https://doi.org/10.1007/s00431-008-0866-z. PMid:18998164
  • Lee P, Tai DYH. Clinical features of patients with acute organophosphate poisoning requiring intensive care. Intensive Care Med. 2001; 27(4):694–9. https://doi.org/10.1007/s001340100895. PMid:11398695
  • Sungur M, Güven M. Intensive care management of organophosphate insecticide poisoning. Crit Care. 2001; 5(4):211–15. https://doi.org/10.1186/cc1025. PMid:11511334. PMCid:PMC37406
  • Ahmed SM, Das B, Nadeem A, Samal RK. Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. Indian J Anaesth. 2014; 58(1):11–17. https://doi.org/10.4103/0019-5049.126780. PMid:24700893. PMCid:PMC3968644
  • Amin DM, Abaza MT, Azawy DS El, Ahmed AI. Morbidity and mortality indicators in acute organophosphate poisoning in Zagazig University Hospital, Egypt: Retrospective study. Occup Dis Environ Med. 2018; 06(04):130–40. https://doi.org/10.4236/odem.2018.64011
  • Hodeib A, Khalifa H. Corrected QT Interval as a predictor of outcomes in acute organophosphate poisoning cases. Ain Shams Journal of Forensic Medicine and Clinical Toxicology. 2020; 34(1):34–40. https://doi.org/10.21608/ajfm.2020.68125
  • Gündüz E, Dursun R, Icer M, et al. Factors affecting mortality in patients with organophosphate poisoning. Journal of the Pakistan Medical Association. 2015; 65(9):967–72.
  • Elshamy RA, Abdel A, Hassan H, El-naggar SAE, Abd M, El-shafei DA. Pesticides among agricultural workers at Mit-Ghamr. 2019; 25(2):187–97. https://doi.org/10.21608/ZUMJ.1999.25525
  • Mahto DK. Serum amylase levels in acute organophosphorus poisoning and it’s correlation with clinical severity. Journal of Medical Science and clinical Research. 2019; 7(2). https://doi.org/10.18535/jmscr/v7i2.118
  • Adinew GM, Asrie AB, Birru EM. Pattern of acute organophosphorus poisoning at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC Res Notes. 2017; 10(1):149. https://doi.org/10.1186/s13104-017-2464-5. PMid:28376842. PMCid:PMC5381028
  • Senanayake N, de Silva HJ, Karalliedde L. A scale to assess severity in organophosphorus intoxication: POP scale. Hum Exp Toxicol. 1993; 12(4):297–9. https://doi.org/10.1177/096032719301200407. PMid:8104007
  • Chaudhary R, Bhandari R, Malla G, Poudel M, Lamsal M. Correlation of clinical score and serum acetylcholinesterase level as a predictor of outcome among patients with acute organophosphate poisoning admitted in emergency ward of a tertiary hospital. Journal of BP Koirala Institute of Health Sciences. 2019; 2(2):19–27. https://doi.org/10.3126/jbpkihs.v2i2.27853
  • Moussa ME, Mohamed SA, Hilal MA, Elnabi MAH, Zaki NA. The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning. Ain Shams Journal of Forensic Medicine and Clinical Toxicology. 2018 Jul; 31:41–50. https://doi.org/10.21608/ajfm.2018.15876
  • Bilal M, Khan Y, Ali S, Naeem A. The pattern of organophosphorus poisoning and it ‘ s short term outcomes in various socioeconomic groups. Khyber Journal of Medical Sciences. 2014; 4(1):11–16.
  • Chintale KN, Patne SV, Chavan SS. Clinical profile of organophosphorus poisoning patients at rural tertiary health care centre. Int J Adv Med. 2016; 3(2):268–74. https://doi.org/10.18203/2349-3933.ijam20161074
  • Hulse EJ, Davies JOJ, Simpson AJ, Sciuto AM, Eddleston M. Respiratory complications of organophosphorus nerve agent and insecticide poisoning: Implications for respiratory and critical care. In: American Journal of Respiratory and Critical Care Medicine. 2014; 90:1342–54. https://doi.org/10.1164/rccm.201406-1150CI. PMid:25419614. PMCid:PMC4299648
  • Vosylius S, Sipylaite J, Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis. Croatian Medical Journal. 2004; 45(6):715–20.
  • Coskun R, Gundogan K, Sezgin GC, et al. A retrospective review of intensive care management of organophosphate insecticide poisoning: Single center experience. Niger J Clin Pract. 2015; 18(5):644– 50. https://doi.org/10.4103/1119-3077.158962. PMid:26096244
  • Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PGM. Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Med Leg Aff. 2009; 16(5):239–47. https://doi.org/10.1016/j.jflm.2008.12.004. PMid:19481704
  • Jabalameli M, Eizadi N, Saghaie M. Predictive outcome of toxicity with organophosphate based on APACHE II scoring system in intensive care unit: A-797. European Journal of Anaesthesiology. 2006; 23:206. https://doi.org/10.1097/00003643-200606001- 00740
  • Kang E-J, Seok S-J, Lee K-H, et al. Factors for determining survival in acute organophosphate poisoning. The Korean journal of internal medicine. 2009; 24(4):362. https://doi.org/10.3904/kjim.2009.24.4.362. PMid:19949736. PMCid:PMC2784981
  • Hrabetz H, Thiermann H, Felgenhauer N, et al. Organophosphate poisoning in the developed world - A single centre experience from here to the millennium. Chem Biol Interact. 2013; 206(3):561–8. https://doi.org/10.1016/j.cbi.2013.05.003. PMid:23685200
  • Baradari AG, Firouzian A, Davanlou A, Aarabi M, Daneshiyan M, Kiakolaye YT. Comparison of patients’ admission, mean and highest sofa scores in prediction of ICU mortality: A prospective observational study. Materia socio-medica. 2016; 28(5):343. https://doi.org/10.5455/msm.2016.28.343-347. PMid:27999481. PMCid:PMC5149442
  • Shabir A, Maqbool M. Accuracy of SOFA score in predicting outcome in medical patients with various diagnosis in intensive care unit in a tertiary care hospital in Northern India. International Journal of Contemporary Medical Research. 2017; 4(1):168–72.
  • Shaoxin Y, Gao Y, Ji W, Song J, Mei X. Shaoxin Yuan, MS. 2018; 21:1-5.
  • Bardin PG, van Eeden SF, Moolman JA, Foden AP, Joubert JR. Organophosphate and carbamate poisoning. Arch Intern Med. 1994; 154(13):1433–41. https://doi.org/10.1001/archinte.154.13.1433. PMid:8017998
  • Nigg HN, Knaak JB. Blood cholinesterases as human biomarkers of organophosphorus pesticide exposure. Reviews of Environmental Contamination and Toxicology. 2000; 163:29–111. https://doi.org/10.1007/978-1-4757-6429-1_2. PMid:10771584
  • Bhattarai MD, Singh DL, Chalise BS, Koirala P. A case report and overview of organophosphate (OP) poisoning. Kathmandu University Medical Journal. 2006; 4 NO. 1(13):100–4.
  • Sen DR, Nayak DJ, Khadanga DS. Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning. International Journal of Medical Research and Review. 2014; 2(3):185–9. https://doi.org/10.17511/ijmrr.2014.i03.03
  • Hiremath P, Rangappa P, Jacob I, Rao K. Pseudocholinesterase as a predictor of mortality and morbidity in organophosphorus poisoning. Indian J Crit Care Med. 2016; 20(10):601–4. https://doi.org/10.4103/0972-5229.192052. PMid:27829717. PMC id:PMC5073776
  • Manar HA, Nashwa MS, Hebatallah HA. Lactate and creatine phosphokinase as potential independent predictors of organophosphrus poisoning severity in Zagazig University Hospital Patients, Egypt. J Toxicol Environ Health Sci. 2017; 9(8):73–82. https://doi.org/10.5897/JTEHS2017.0400
  • Yardan T, Baydin A, Acar E, et al. The role of serum cholinesterase activity and S100B protein in the evaluation of organophosphate poisoning. Hum Exp Toxicol. 2013; 32(10):1081–8. https://doi.org/10.1177/0960327112474850. PMid:23424211
  • Benaissa ML, Mégarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003; 29(8):1372–75. https://doi.org/10.1007/s00134-003-1866-0. PMid:12856122
  • Hulme J, Sherwood N. Severe lactic acidosis following alcohol related generalised seizures. Anaesthesia. 2004; 59(12):1228–30. https://doi.org/10.1111/j.1365-2044.2004.03962.x. PMid:15549986
  • Jorens PG, Demey HE, Schepens PJC, et al. Unusual D‐lactic acid acidosis from propylene glycol metabolism in overdose. Journal of Toxicology: Clinical Toxicology. 2004; 42(2):163–9. https://doi.org/10.1081/CLT-120030942. PMid:15214621
  • Gunnerson KJ. Clinical review: The meaning of acidbase abnormalities in the intensive care unit part I-epidemiology. Crit Care. 2005; 9(5):1–9. https://doi.org/10.1186/cc3796. PMid:16285034. PMCid:PM C1297610
  • Kompanje EJO, Jansen TC, van der Hoven B, Bakker J. The first demonstration of lactic acid in human blood in shock by Johann Joseph Scherer (1814-1869) in January 1843. Intensive Care Med. 2007; 33(11):1967– 71. https://doi.org/10.1007/s00134-007-0788-7. PMid: 17661014. PMCid:PMC2040486
  • Liu XW, Jin Y, Liu Z. Arterial lactate as a predictor of mortality in emergency department patients with acute paraquat poisoning. Chinese Journal of Emergency Medicine. 2013; 22(11):1219–25.
  • Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med. 2005; 20(5):255– 71. https://doi.org/10.1177/0885066605278644. PM id:16145217
  • Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus non-lactate metabolic acidosis: A retrospective outcome evaluation of critically ill patients. Crit Care. 2006;10(1):R22. https://doi.org/10.1186/cc3987. PM id:16507145. PMCid:PMC1550830
  • Inoue S, Saito T, Tsuji T, et al. Lactate as a prognostic factor in carbon monoxide poisoning: A case report. Am J Emerg Med. 2008; 26(8). https://doi.org/10.1016/j.ajem.2008.01.048. PMid:18926368
  • Moon JM, Shin MH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: In the emergency department. Human and Experimental Toxicology. 2011; 30(8):836–43. https://doi.org/10.1177/0960327110384527. PMid:20876159
  • Lionte C, Sorodoc V, Tuchilus C, Cimpoiesu D, Jaba E. Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures. Human and Experimental Toxicology. 2017; 36(7):651–62. https://doi.org/10.1177/0960327116660866. PMid:27457800
  • Masyuk M, Wernly B, Lichtenauer M, et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med. 2019; 45(1):55–61. https://doi.org/10.1007/s00134-018-5475-3. PMid:30478622
  • Dong N, Liu J, Wang Z, Gao N, Pang L, Xing J. Development of a practical prediction scoring system for severe acute organophosphate poisoning. J Appl Toxicol. 2020;(November 2019):1-8. https://doi.org/10.1002/jat.3950. PMid:32030807
  • Sahin IÇ, Onbasi K, Sahin H, Karakaya C, Ustun Y, Noyan T. The prevalence of pancreatitis in organophosphate poisonings. Hum Exp Toxicol. 2002; 21(4):175–7. https://doi.org/10.1191/0960327102ht234cr. PMid:12099618
  • Chaturvedi A, Dutta S, Sarkar S, et al. Prevalence of hyperamylasemia and acute pancreatitis in organophosphate poisonings. Journal of Dental and Medical Sciences. 2014; 13(1):59–62. https://doi.org/10.9790/0853-13115962
  • Adhil S, Sudharsan S. Estimation of serum amylase and lipase levels in correlation with clinical outcome of OP poisoning. Int J Modn Res. 2015; 3(10):849–51.
  • Salame NR, Wani SA. Study of serum amylase levels in organophosphate poisoning. Int J Biomed Adv Res. 2017; 8(12):450–4.
  • Sert Aİ, Kılıç ET, Akdemir MS, Kavak GÖ. Retrospective analysis of organophosphate poisonings in an intensive care unit in Turkey: A single-center study. Dubai Medical Journal. 2018;1(1–4):13–18. https://doi.org/10.1159/000493768
  • Nagabhiru S. A prospective study of serum amylase levels in acute organophosphorus poisoning and its relationship with its severity and outcome. The J Assoc Phys India. 2020; 68(1):102.
  • Gokel Y, Gulalp B, Acikalin A. Parotitis due to organophosphate intoxication. J Toxicol Clin Toxicol 2002; 40(5):563–5. https://doi.org/10.1081/CLT-120014648. PMid:12215051
  • Sung J, Kim SJ, Lee HANBO. Anticholinesterase Induces. 1998;(September):1135–44. https://doi.org/10.1002/(SICI)1097-4598(199809)21 :9<1135: :AIDMUS4> 3.0.CO;2-8
  • Koirala M, Baral BR, Lamichanne B, Hospital WR, Hospital WR. Clinical significance of serum amylase and glucose level in organophosphorus poisoning. Medical Journal of Pokhara Academy of Health Sciences. 2019; 2(1):121–5. https://doi.org/10.3126/ mjpahs.v2i3.26105

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  • Predictors of Severity and Survival in Acute Cases of Organophosphorous Poisoning at Zagazig University Hospitals: Prospective Cohort Study

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Authors

Hend S. Eisa
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Elsharquia – 44511, Egypt
Mahmoud A. Nomier
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Elsharquia – 44511, Egypt
Manar H. Arafa
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Elsharquia – 44511, Egypt
Eman El-Sayed Khayal
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Elsharquia – 44511, Egypt

Abstract


Organophosphorous Insecticides (OPIs) have been profusely used and toxicity by them are common. Scoring systems are used as predictors of survival in severely ill patients. OPIs toxicity is associated with multiple biochemical abnormalities like changes in serum lactate. The aim of this study was evaluation the role of Acute physiology and chronic health evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores, acetyl cholinesterase (AChE), and lactate enzymes in assessing severity, outcome and complications in acutely OPIs poisoned patients. This prospective cohort study was carried out on 36 OPIs poisoned patients admitted to Zagazig University Hospitals in seven months’ period from the beginnings of May 2019 till the end of November 2019. The Peradeniya Organophosphorus Poisoning (POP), APACHE II and SOFA scores were calculated on the first day of admission. Serum lactate, and AChE enzymes were measured on admission and after 24 h. The cases were aged from 3 to 66 years old. As result of the study: APACHE II and SOFA scores were predictors of severity. The decrease in AChE level was correlated with the severity and complications but it was not predictor of them. Lactate was predictor of outcome and complications. Thus, APACHE II and SOFA scores can have used as predictors of severity. Also, lactate can be used as a predictor of outcome and complications.

Keywords


Acetyl Cholinesterase, Acute Physiology and Chronic Health Evaluation II (APACHE II), Lactate, Organophosphorous Insecticides, Sequential Organ Failure Assessment (SOFA) Score.

References





DOI: https://doi.org/10.18311/ti%2F2021%2Fv28i3%2F26657