Prognostic value of serial serum cholinesterase activities in organophosphate poisoned patients.
OBJECTIVE
Organophosphate (OP) poisoning is a worldwide concern. Several factors have been identified to predict outcomes of OP poisoned patients. This study focuses on the relationship between the trend in Serum cholinesterase (SChE) activity and its clinical outcome in acute OP poisoned patients.


METHODS
We retrospectively reviewed the medical records of all adult acute OP poisoned patients that visited the Emergency Department from 2000 to 2006. These patients were divided into two groups: the deceased patients as the sample group and all others as the control group. We collected data on the following: demographical factors, poisoning history, clinical manifestation, Glasgow Coma Scale (GCS), APACHE II score, all SChE data within 48 hours, hourly 2-PAM dosage, intubation, and mortality. Chi-Square test then examined the relationship between the trend of SChE activity and mortality.


RESULTS
86 patients were enrolled. Follow-up measurements of SChE activity within 48 hours of poisoning were available in 50 cases. Among these, eight patients died. We found no significant difference between the sample and control groups on initial SChE activity, time interval to initial SChE data, and hourly 2-PAM dosage. The sampled group possessed a worse GCS score, lower systolic blood pressure, and a higher APACH II score. Increase patient mortality rates associated with the absence of elevating SChE activity within 48 hours of poisoning. (P = .006, odds ratio:11).


CONCLUSIONS
We propose that the absence of elevating SChE activity level within 48 hours of poisoning appears to associate with higher mortality in acute OP poisoned patients.
Chen
Hsien-Yi
HY
Department of Emergency Medicine, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan.
Wang
Warren Wei-Jen
WW
Chaou
Chung-Hsien
CH
Lin
Chih-Chuan
CC
D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D002802:Cholinesterases / Q000097:blood*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning; D010575:Pesticides / Q000506:poisoning*; D011041:Poisoning / Q000201:enzymology / Q000401:mortality / Q000628:therapy; D011220:Pralidoxime Compounds / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000931:Antidotes; D010575:Pesticides; D011220:Pralidoxime Compounds; D002802:Cholinesterases; C028797:pralidoxime