Addition of Immunosuppressive Treatment to Hemoperfusion Is Associated with Improved Survival after Paraquat Poisoning: A Nationwide Study

• Published in: PloS one Vol. 9; no. 1; p. e87568
• Main Authors: Wu, Wen-Pyng, Lai, Ming-Nan, Lin, Ching-Heng, Li, Yu-Fen, Lin, Ching-Yuang, Wu, Ming-Ju
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.01.2014; Public Library of Science (PLoS)
• Subjects: Adult; Age; Age Factors; Clinical trials; Cohort Studies; Cyclophosphamide; Cyclophosphamide - therapeutic use; Dexamethasone; Dexamethasone - therapeutic use; Diabetes; Glucocorticoids; Health insurance; Hemoperfusion; Hemoperfusion - methods; Herbicides; Humans; Immunosuppression; Immunosuppression Therapy - methods; Immunosuppressive agents; Kidneys; Lupus; Male; Medicine; Methylprednisolone; Methylprednisolone - therapeutic use; Middle Aged; Mortality; National health insurance; Paraquat; Paraquat - poisoning; Patients; Poisoning; Poisoning - drug therapy; Poisoning - epidemiology; Poisoning - therapy; Population studies; Proportional Hazards Models; Renal failure; Respiratory failure; Retrospective Studies; Studies; Survival; Survival Rate; Taiwan - epidemiology; Treatment Outcome; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087568

Paraquat poisoning associates very high mortality rate. Early treatment with hemoperfusion is strongly suggested by animal and human studies. Although the survival benefit of additional immunosuppressive treatment (IST) in combination with hemoperfusion is also reported since 1971, the large-scale randomized control trials to confirm the effects of IST is difficult to be executed. Therefore, we designed this nationwide large-scale population-based retrospective cohort study to investigate the outcome of paraquat poisoning with hemoperfusion and the additional effects of IST combined with hemoperfusion. This nationwide retrospective cohort study utilized data retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. A total of 1811 hospitalized patients with a diagnosis of paraquat poisoning who received hemoperfusion between 1997 and 2009 were enrolled. The mean age of all 1811 study subjects was 47.3 years. 70% was male. The overall survival rate was only 26.4%. Respiratory failure and renal failure were diagnosed in 56.2% and 36% patients. The average frequency of hemoperfusion was twice. IST was added in 42.2% patients. IST significantly increases survival rate (from 24.3% to 29.3%, P<0.001). The combined IST with methylprednisolone, cyclophosphamide and dexamethasone associates with the highest survival rate (48%, P<0.001). Moreover, patients younger than 45 years of age in the IST group had the best survival (41.0% vs. 33.7%, p<0.001). Our results support the use of IST with hemoperfusion for paraquat-poisoned patients. The best survival effect of IST is the combination of methylprednisolone, cyclophosphamide and daily dexamethasone, especially in patients with younger age.