title: Chlorpyrifos is associated with slower serum cholinesterase recovery in acute organophosphate-poisoned patients.
abstract: OBJECTIVE
  Organophosphate poisoning (OPP) accounts for 200,000 deaths annually in developing countries. Serum cholinesterase (SChE) is of diagnostic value in patients with OPP and is checked repeatedly during the course of treatment. This study aimed to investigate the recovery pattern in patients with OPP using linear mixed models.
  
  
  METHODS
  Using a retrospective cohort study design, we included 212 adult OPP patients who had visited the emergency department (ED) in a tertiary medical center between 2000 and 2010. One hundred and thirty-one patients were available for analysis, as 81 patients did not meet the criteria and were excluded. Information regarding basic personal characteristics, initial vital signs and severity scores, laboratory data, type and amount of organophosphate ingested, treatment, and serial SChE values was collected. A random coefficient model with a random intercept and a random slope of time were added to address the dynamic relationships of SChE with time and other associated factors.
  
  
  RESULTS
  The initial SChE activity and recovery rates varied among patients with OPP. The type of organophosphate, the first SChE activity, and the initial APACHE II score were significantly related to the SChE recovery trend. Chlorpyrifos and methamidophos had significantly slower and faster SChE recovery rates, respectively, than other organophosphates. Sex, dose of Pralidoxim (2-PAM), and delay in obtaining medical assistance did not significantly affect SChE recovery.
  
  
  CONCLUSIONS
  This study demonstrated the pattern and associated correlates of SChE activity recovery in patients with acute OPP. Chlorpyrifos appeared to have a slower SChE activity recovery rate than other organophosphates.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Taoyuan , Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Chaou
authors.forename: C C
authors.initials: CC
authors.lastname: Lin
authors.forename: H Y
authors.initials: HY
authors.lastname: Chen
authors.forename: C H
authors.initials: CH
authors.lastname: Lee
authors.forename: T H H
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000931:Antidotes / Q000627:therapeutic use; D004390:Chlorpyrifos / Q000633:toxicity*; D002802:Cholinesterases / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007306:Insecticides / Q000633:toxicity*; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D009946:Organothiophosphorus Compounds / Q000633:toxicity; D011220:Pralidoxime Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013406:Suicide, Attempted; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D000931:Antidotes; D007306:Insecticides; D009946:Organothiophosphorus Compounds; D011220:Pralidoxime Compounds; C014655:methamidophos; D002802:Cholinesterases; D004390:Chlorpyrifos; C028797:pralidoxime