Prediction Of Prognosis In Patients With Acute Organophosphorus Poisoning By Change In Cholinesterase

Objective:By analyzing the clinical data of patients with acute organophosphorus pesticide poisoning（AOPP）,this study aimed to investigate the risk factors affecting the prognosis with AOPP and provide a basis for the assessment of the condition of patients with AOPP.Methods:A retrospective analysis of the clinical data of 242 patients with AOPP hospitalized in the First Hospital of Jilin University from January 2018 to August 2022,including vital signs at admission,results of laboratory test and the serum levels of Ch E activity.All of the 242 patients(group D_1-2)were continuously monitored for the serum levels of Ch E activity at least the first day and the second day after admission,and 220 of them(D_1-3 group)were continuously monitored for the serum levels of Ch E activity on the first day,the second day,and the third day of admission.The change of the serum levels of Ch E activity from the first day to the second day(Ch E_D2-D1)and from the first day to the third day(Ch E_D2-D1)were calculated.ROC analyses were calculated to determine values at the maximum Youden index as cut-off points for continuous variables.Based on the data set above,the patients were divided into survival and death groups according to the prognosis,and basic information,laboratory data were collected,and univariate analysis and multivariate Logistic regression analysis were conducted to study the independent risk factors of AOPP.Result:1,The serum levels of Ch E activity on the first day and the second day of admission in group D_1-2[Ch E_D1:448.5（238.75,1051.25）U/L in the survival group and 288.0（223.25,475.25）U/L in the death group,P=0.007,Ch E_D2:676.5（250.75,1569.50）U/L in the survival group and 230.5（150.25,333.50）U/L in the survival group and-67.5（-162.25,10.75）U/L in the death group,P<0.001]and the change value from the first day to the second day[(Ch E_D2-D1:151.0（1.50,532.75）U/L in the survival group and-67.5（-162.25,10.75）U/L in the death group,P<0.001]were statistically significant between the survival and death groups.ROC curve analysis showed that the AUC value of Ch E_D2-D1 was 0.772[95%confidence interval=（0.691,0.852）],sensitivity was79.2%and specificity was 72.5%,and the cut-off value was-21.5.Single factor logistic regression suggested that age[OR=1.037,P=0.001),heart rate at admission（OR=1.041,P<0.001）,respiratory rate at admission（OR=1.151,P<0.001）,presence of shock at admission（OR=25.392,P<0.001）,Lac（OR=1.175,P<0.001）,AST（OR=1.006,P=0.037）,BUN（OR=1.321,P=0.001）,Cr（OR=1.029,P<0.001）,sodium ion（OR=1.003,P=0.042）,NE%（OR=6808.168,P=0.001）,with Ch E_D2-D1<-21.5U/L（OR=10.043,P<0.001）were positively correlated with the prognosis of AOPP patients;GCS score at admission（OR=0.657,P<0.001）,oxygenation index at admission（OR=0.987,P<0.001）,p H（OR=0.001,P<0.001）,BE（OR=0.868,P<0.001）,albumin（OR=0.897,P<0.001）,Ch E_D1/100（OR=0.901,P=0.011）,Ch E_D2/100（OR=0.879,P=0.002）,and Ch E_D2-D1/100（OR=0.857,P=0.002）were negatively correlated with the prognosis of AOPP patients.Multifactorial logistic regression suggested that respiratory rate on admission（OR=1.117,P=0.012）,presence of shock on admission（OR=7.413,P=0.001）,Cr（OR=1.023,P=0.001）,and presence of Ch E_D2-D1<-21.5U/L（OR=3.402,P=0.038）were independent risk factor and GCS score at admission（OR=0.812,P=0.006）was an independent protective factor affecting the prognosis.2,In D_1-3 groups,The serum levels of Ch E activity on the first day,the second day,and the third day of admission[Ch E_D1:448.5（244.00,1077.75）U/L in the survival group and 293.0（235.50,529.25）U/L in the death group,P=0.031,Ch E_D2:709.5（255.75,1596.50）U/L in the survival group and 217.5（150.25,333.25）U/L,P<0.001,Ch E_D3:1256.0（488.75,2398.00）U/L in the survival group and 250.0（174.00,459.50）U/L in the death group,P<0.001)and the change value from the first day to the third day[Ch E_D3-D1:650.5（121.00,1203.00）U/L in the survival group and-60.5（-170.00,170.50）U/L in the death group,P<0.001)were statistically significant between the survival and death groups.ROC curve analysis showed that the AUC value of Ch E_D3-D1was 0.802[95%confidence interval=（0712,0.891）],P<0.001,sensitivity was70.3%and specificity was 82.1%,the cut-off value was 279.single logistic regression suggested that age（OR=1.055,P<0.001）,heart rate at admission（OR=1.034,P=0.001）,respiratory rate at admission（OR=1.128,P<0.001）,and presence of shock at admission（OR=22.763,P<0.001）,BUN（OR=1.313,P=0.005）,Cr（OR=1.022,P<0.001）,sodium ion（OR=1.121,P=0.025）,NE%（OR=1699.826,P=0.014）,and Ch E_D2-D1<279 U/L（OR=10.043,P<0.001）were positively associated with the prognosis of AOPP patients;GCS score at admission（OR=0.672,P<0.001）,oxygenation index at admission（OR=0.989,P<0.001）,p H（OR=0.004,P=0.002）,BE（OR=0.894,P=0.001）,albumin（OR=0.911,P=0.002）,Ch E_D1/100（OR=0.905,P=0.034）,Ch E_D2/100（OR=0.885,P=0.008）,Ch E_D3/100（OR=0.886,P=0.001）,Ch E_D3-D1/100（OR=0.871,P<0.001）were negatively associated with the prognosis of AOPP patients.Multifactorial logistic regression suggested that respiratory rate on admission（OR=1.187,P=0.007）,presence of shock on admission（OR=12.012,P=0.001）,Cr（OR=1.029,P=0.001）,and Ch E_D3-D1<279 U/L（OR=11.47,P=0.002）were independent risk factors and GCS score at admission（OR=0.814,P=0.01）was an independent protective factor affecting the prognosis.Conclusions:At the early stage of AOPP,serum Ch E activity and the change of serum Ch E activity have certain value in the diagnosis of AOPP,Ch E_D2-D1<-21.5U/L and Ch E_D3-D1<279U/L were independent risk factor affecting the prognosis.AOPP patients with elevated respiratory rate on admission,presence of shock,elevated Cr,and low GCS scores were at higher risk of death.