early hemoperfusion may improve survival of severely paraquat-poisoned patients早期血液灌流可以改善严重paraquat-poisoned的病人的生存.pdfVIP

Early Hemoperfusion May Improve Survival of Severely Paraquat-Poisoned Patients Ching-Wei Hsu1,2, Ja-Liang Lin1,2*, Dan-Tzu Lin-Tan1,2, Kuan-Hsing Chen1,2, Tzung-Hai Yen1,2, Mai- Szu Wu2,3, Shih-Chieh Lin1,2 1 Division of Clinical Toxicology, Department of Nephrology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taoyuan, Taiwan, Republic of China, 2 Chang Gung University and School of Medicine, Taoyuan, Taiwan, Republic of China, 3 Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China Abstract Background: Thousands of paraquat (PQ)-poisoned patients continue to die, particularly in developing countries. Although animal studies indicate that hemoperfusion (HP) within 224 h after intoxication effectively reduces mortality, the effect of early HP in humans remains unknown. Methods: We analyzed the records of all PQ-poisoned patients admitted to 2 hospitals between 2000 and 2009. Patients were grouped according to early or late HP and high-dose (oral cyclophosphamide [CP] and intravenous dexamethasone [DX]) or repeated pulse (intravenous methylprednisolone [MP] and CP, followed by DX and repeated MP and/or CP) PQ therapy. Early HP was defined as HP ,4 h, and late HP, as HP $4 h after PQ ingestion. We evaluated the associations between HP ,4 h, ,5 h, ,6 h, and ,7 h after PQ ingestion and the outcomes. Demographic, clinical, laboratory, and mortality data were analyzed. Results: The study included 207 severely PQ-poisoned patients. Forward stepwise multivariate Cox hazard regression analysis showed that early HP ,4 h (hazard ratio [HR] = 0.38, 95% confidence interval (CI) 0.16–0.86; P = 0.020) or HP ,5 h (HR = 0.60, 95% CI: 0.39–0.92; P = 0.019) significantly decreased the mortality risk. Further analysis showed that early HP reduced the mortality risk only in patie