Effects Of Early Blood Drug Concentration In Paraquat Poisoning Patients On Prognosis And Therapeutic Efficacy Of Hemopurification

Objective To explore early blood drug concentration in paraquat(PQ)poisoning patients for prognosis evaluation and its impact on treatment effect of hemopurification.Methods Retrospective analysis of 469 patients with acute PQ poisoning in emergency department of Xijing Hospital from January 2013 to December 2016.1.Patients were divided into death group(n=182)and survival group(n=287)due to prognosis,and logistic regression analysis was used to analyze the risk factors which affect prognosis of acute PQ poisoning patients.2.Patients were divided into hemoperfusion(HP)group(2013-2014,n=186)and HP+continuous venovenous hemofiltration(CVVH)(2015-2016,n=132)group due to methods of hemopurification,and patients in the two groups were also divided into low group,moderate group and high group due to PQ plasma concentration.Results 1.The results of logistic regression analysis showed that poisoning time(p<0.01,OR=0.029,95%CI: 0.019~0.039),PQ plasma concentration(p<0.01,OR=0.038,95%CI: 0.032~0.044)and lactic acid(p<0.01,OR=0.115,95%CI: 0.091~0.139)were prognostic risk factors.The area under the curve of poisoning time was 0.639(95%CI: 0.587~0.691,p<0.01),the cut-off value was 6.2h(sensitivity: 0.623,specificity: 0.658,Youden’s index: 0.281).The area under the curve of PQ plasma concentration was 0.782(95%CI: 0.733~0.830,p<0.01),the cut-off value was 3.0μg/ml(sensitivity: 0.799,specificity: 0.741,Youden’s index: 0.540).The area under the curve of lactic acid was 0.736(95%CI: 0.685~0.788,p<0.01),the cut-off value was 3.2mmol/L(sensitivity: 0.786,specificity: 0.690,Youden’s index: 0.476).2.Mortality and morbidity was lower in HP+CVVH group than in HP group(p<0.05),but there was no statistical difference in the survival time of deaths but between the two groups(p>0.05).There was no statistical difference in mortality,morbidity and the survival time of deaths between HP group and HP+CVVH group at low PQ plasma concentration(<1.0μg/ml)and high PQ plasma concentration(>3.0μg/ml)(p>0.05).Mortality and the incidence of acute respiratory distress syndrome(ARDS),pulmonary fibrosis and multiple organ dysfunction syndrome(MODS)was lower and the survival time of deaths was longer in HP+CVVH group at moderate PQ plasma concentration,and there was a statistical difference(p<0.05).Conclusion Poisoning time,PQ plasma concentration and lactic acid are prognostic risk factors.Early blood drug concentration and treatment effect of hemopurification have a close close relationship.