title: Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids.
abstract: OBJECTIVE
  To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning.
  
  
  METHODS
  A total of 111 patients with severe PQ poisoning and dark-blue color in urine tests within 24 h of intoxication were included prospectively. The control group consisted of 52 patients who were admitted between 1998 and 2001 and who received high doses of CP (2 mg/kg per day) and DEX (5 mg every 6 h) for 14 days. The study group consisted of 59 patients who were admitted from 2002 to 2007 and who received initial MP (1 g) for 3 days and CP (15 mg/kg per day) for 2 days, followed by DEX (5 mg every 6 h) until a PaO(2) of >80 mmHg had been achieved, or treated with repeated 1 g MP for 3 days and 1 g CP for 1 day if the PaO(2) was <60 mmHg.
  
  
  RESULTS
  There were no differences between the two groups with regard to baseline data and plasma PQ levels. The study group patients had a lower mortality rate (39/59, 66%) than the control group patients (48/52, 92%; P=0.003, log-rank test). Multivariate Cox regression analysis revealed that the repeated pulse therapy was correlated with decreased hazard ratios (HR) for all-cause mortality (HR=0.50, 95% CI 0.31-0.80; P=0.004) and death from lung fibrosis-related hypoxemia (HR=0.10, 95% CI 0.04-0.25; P<0.001) in severely PQ-intoxicated patients.
  
  
  CONCLUSIONS
  Repeated pulses of CP and MP, rather than high doses of CP and DEX, may result in a lower mortality rate in patients with severe PQ poisoning.
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199, Tung-Hwa North Road, Taipei, Taiwan, ROC. jllin99@hotmail.com
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning*; D011446:Prospective Studies; D020551:Pulse Therapy, Drug / Q000379:methods; D012044:Regression Analysis; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D003520:Cyclophosphamide; D010269:Paraquat