Lack of prognostic role for Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus Toxicological ICU poisoned patients

Abstract

Self-poisoning with organophosphorus (OPs) pesticide is a serious clinical problem across Asian countries. The aim of the present study was to assess the value of the Glasgow Coma Scale (GCS), serum acetylcholinesterase (SChE) and leukocyte on the length of stay and mortality due to OP poisoning as a prognostic value. We studied acutely OP-poisoned patients who had been admitted to the toxicological intensive care unit (TICU) of Loghman Hakim Hospital, from October 2010 to September 2011. Data including sex, age, cause of contact, ICU length of stay, muscarinic / nicotinic symptoms, initial Leukocyte, SChE and GCS levels were collected for under-study patients. Based on the patients' survival, they were divided into 2 groups, survivors and non-survivors (n=6). Thirty five eligible patients with a mean± SD age of 32.5±17 (range 2-72 years) were enrolled. Of these, 23(65.7%) were male. Suicide attempt was recorded in 31(88.6%) patients. Most of the patients had GCS above 10. The SChE ≥ 50% normal (≥1600 mU/ml) was reported in 45.7%. The mortality was 17.1% (n=6). The mean±SD and the median length of ICU stay in survivors were 7± 4 and 8. There was no statistically difference between the survivors and non-survivors according to the mean SChE, leukocyte and GCS. Only one dead patient had GCS lower than 10. (P>.05) Our results indicate that the GCS, SChE and leukocyte levels are not effective predictive factors for the outcome; however, they are useful in early diagnosis of OP poisoning. [Arezou Mahdavinejad, Abdolkarim Pajoumand, Behjat Barari, Alireza Salimi, and Haleh Talaie. Lack of prognostic role for Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus Toxicological ICU poisoned patients. Life Sci J 2014;11(8s):563-567] (ISSN:1097-8135). http://www.lifesciencesite.com. 117 Keyword: GCS; serum acetylcholinesterase; leukocyte levels; organophosphorus poisoning; intensive care unit Introduction: Self-poisoning with organophosphorus (OPs) pesticide is a serious clinical and public-health problem across Asian countries that have a great deal of agricultural activities(1-2). Low-cost and easy availability of OPs in developing countries such as India, Nicaragua and Iran make intentional and unintentional poisonings source (3). It is believed that between 750,000 and 3,000,000 OPs poisoning occur globally each year and estimated 200,000 die, annually, largely in the Asia-Pacific region(1, 4-5). They have also been used in terrorist or military attacks, as chemical warfare nerve agents (1). Nerve agent Tabun was used for the first time in 1984 by Iraqi army against Iran. From 1983 to 1988, Iraq used nerve agents such as Sarin and Tabun against Iranian combatants and the civilians (5). OPs intoxication induces irreversible inhibition of acetylcholinesterase at the muscarinic and nicotinic synapses, due to inhibit the metabolism of acetylcholine (ACh). The accumulation of large amounts of ACh at the cholinergic synapses leads to acute cholinergic crisis, that it characterized by receptor overstimulation and a range of muscarinic, nicotinic, and central effects (6). The severity of OP poisoning depends upon the toxicity potential of the agents, the kind of exposure and the time of treatment initiation (7). Immediate resuscitation, including circulatory support and mechanical ventilation is necessary in severely intoxicated patients (4). This poisoning has high inpatient mortality and many patients have cardiorespiratory arrests after admission (8). Prognostic evaluation and estimation is very much critical and important for the outcome of treatment .There are limited studies in which the Glasgow Coma Scale (GCS), serum acetylcholinesterase and leukocyte have been mentioned as valuable prognostic factors (4, 7, 9-10). The aim of the present study was to assess the value of the Glasgow Coma Scale (GCS), serum acetylcholinesterase and leukocyte on the length of Life Science Journal 2014;11(8s) http://www.lifesciencesite.com http://www.lifesciencesite.com lifesciencej@gmail.com 564 stay and mortality due to OP poisoning as prognostic and predictable outcome. Materials and methods: Acutely OPpoisoned patients who had been admitted within 24 hours after OP exposure to the toxicological intensive care unit (TICU) of Loghman Hakim Hospital Poison Center (LHHPC), from October 2010 to September 2011were recruited in this cross-sectional study. The hospital is a unique care teaching and referral poison treatment center in Tehran with nearly an annual average of 20000 hospital visits. Exclusion criteria were included: uncertain history of exposure, uncertain agent, transferring to other hospitals, carbamate poisoning and absence of initial SChE activity, WBC and GCS. Data retrospectively were collected from the patients' records by the study trained doctors, who filled the questionnaire including sex, age, time relapsed between exposure and admission to the hospital, cause of contact, muscarinic and nicotinic symptoms, Leukocyte levels (using the Sysmex KX-21 N Automated Hematology analyzer in Logman Hospital Laboratory), acetyl cholinesterase levels (spectrophotometric method usingHitachi 911 autoanalyser in Logman Hospital Laboratory), GCS levels on admission and length of stay of these patients. This study has ethics review committee approval from Shahid Beheshti University of Medical Sciences. The statistical analysis was performed with SPSS version 16 (SPSS Inc., Chicago, IL, USA). Data were analyzed through appropriate statistical testes, such as Chi-square test (χ2), and the MannWhitney U test. P-values equal to or less than 0.05 considered significant.

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