Fei He1, Peng Xu1, Jun Zhang1, Qiuling Zhang1, Shuangshuang Gu1, Yao Liu1, Jun Wang2. 1. Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China. 2. Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China. Electronic address: wangjun691119@163.com.
Abstract
PURPOSE: Paraquat (PQ) is widely used in developing countries. Accidental or suicidal PQ poisoning is a public health concern due to lack of effective treatment. Because the role of pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide for PQ poisoning is uncertain, we performed a meta-analysis to investigate the efficacy and safety of the therapy. METHOD: A systematic literature search for randomized controlled trials (RCTs) and other clinical studies was performed in Pub Med, Embase, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature and Retrieval System, and Chinese Medical Current Contents. We estimated pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) using a fixed effect model or random effect model. Outcomes included mortality, incidence of acute renal failure (ARF) and hypoxia, and leucopenia. RESULTS: Five studies (three RCTs) involving 332 PQ poisoning patients met the criteria. The mortality of moderate to fulminant poisoning patients receiving the pulse therapy was lower than that of the controls (60.4% vs. 85.3%; RR 0.71, 95% CI: 0.59, 0.86, P=0.0004). The therapy also reduced the mortality of patients with moderate to severe PQ poisoning (45.1% vs. 79.1%, RR 0.45; 95% CI: 0.28, 0.75, P=0.002). However, the therapy did not decrease the incidence of ARF and hypoxia. In addition, the pulse therapy caused more leucopenia than the controls (36.9% vs. 2.6%; RR: 9.12; 95% CI: 3.65, 22.81, P<0.00001). CONCLUSION: Pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide may reduce the mortality of PQ poisoning patients, although the therapy may cause leucopenia.
PURPOSE:Paraquat (PQ) is widely used in developing countries. Accidental or suicidal PQpoisoning is a public health concern due to lack of effective treatment. Because the role of pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide for PQpoisoning is uncertain, we performed a meta-analysis to investigate the efficacy and safety of the therapy. METHOD: A systematic literature search for randomized controlled trials (RCTs) and other clinical studies was performed in Pub Med, Embase, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature and Retrieval System, and Chinese Medical Current Contents. We estimated pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) using a fixed effect model or random effect model. Outcomes included mortality, incidence of acute renal failure (ARF) and hypoxia, and leucopenia. RESULTS: Five studies (three RCTs) involving 332 PQpoisoningpatients met the criteria. The mortality of moderate to fulminant poisoningpatients receiving the pulse therapy was lower than that of the controls (60.4% vs. 85.3%; RR 0.71, 95% CI: 0.59, 0.86, P=0.0004). The therapy also reduced the mortality of patients with moderate to severe PQpoisoning (45.1% vs. 79.1%, RR 0.45; 95% CI: 0.28, 0.75, P=0.002). However, the therapy did not decrease the incidence of ARF and hypoxia. In addition, the pulse therapy caused more leucopenia than the controls (36.9% vs. 2.6%; RR: 9.12; 95% CI: 3.65, 22.81, P<0.00001). CONCLUSION: Pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide may reduce the mortality of PQpoisoningpatients, although the therapy may cause leucopenia.
Authors: Sheida Nasr Isfahani; Ziba Farajzadegan; Ali Mohammad Sabzghabaee; Alireza Rahimi; Shiva Samasamshariat; Nastaran Eizadi-Mood Journal: J Res Med Sci Date: 2019-01-31 Impact factor: 1.852