The predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB in prognosis of patients with acute paraquat poisoning

Abstract

Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning. Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017. The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning. The patients’ data were retrieved, including general information, the dose of poison, urinary paraquat concentration, arterial blood gas analysis, alanine transaminase (ALT), total bilirubin (TBIL), uric acid (UA), aspartate transaminase (AST), creatine kinase (CK), CK-MB, B type natriuretic peptide (BNP), lactic dehydrogenase (LDH), high sensitivity troponin T (hsTnT), C-reaction protein (CRP) and procalcitonin (PCT). According to the patient's prognosis within 3 months, the patients were divided into a survival group and a non-survival group. The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve. Collect the last arterial blood gas analysis, and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning. Results Among the 641 patients with acute paraquat poisoning, 315 (49.1%) patients survived and 326 (50.9%) died. Compared with the survival group, patients in the non-survival groupthere were older, had a shorter hospital stay, and had a higher oral paraquat dose and urinary paraquat concentration; Lac, TBIL, UA, AST, CK, CK-MB, BNP, LDH, CRP and PCT were higher, while blood gas analysis index were lower in the non-survival group (P 18.05 U/L often indicated poor prognosis (AUC=0.808, sensitivity 79.7%, specificity 65.8%, Yoden index 0.455, P<0.01). Conclusions In the treatment of patients with acute paraquat poisoning, there are significant differences in extra pulmonary factors such as heart, liver, kidney, electrolytes and inflammatory markers in patients with different prognosis, so the monitoring and follow-up should be improved, in addition to focusing on the presence and treatment of pulmonary fibrosis. In particular, CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning. In the late stage of poisoning, CK-MB, SCr, and blood Na+ have a strong predictive value for the prognosis of the patients, and we should pay attention to the regular follow-up of the above mentioned laboratory items. Key words: Paraquat; Poisoning; Myocardium; Prognosis; Creatine kinase-isoenzyme MB; Multiple organ failure; Multiple factors; Retrospective study; Late stage