title: Prognosis and survival analysis of paraquat poisoned patients based on improved HPLC-UV method.
abstract: Paraquat (PQ) has caused deaths of numerous people around the world. In order to assess the lethal plasma concentration, the patients who acquired acute PQ intoxication were analyzed by plasma concentration monitoring. The plasma PQ concentrations were determined by high performance liquid chromatography (HPLC) which used 5-bromopyrimidine as internal standard and trichloroacetic acid-methanol (1:9) as protein precipitant. The liver, kidney and coagulation function were determined by automatic biochemical analyzer. According to plasma PQ concentration, 90 patients were divided into four groups: trace PQ group (<50ng/mL), low PQ group (<1000ng/mL), medium PQ group (1000-5000ng/mL) and high PQ group (>5000ng/mL). The clinical data from the four groups was statistically analyzed. The results showed the developed HPLC methods exhibited a high degree of accuracy and good linearity within 50-25000ng/mL (R=0.9998). The Spearman's correlation analysis showed PQ concentration had a strong relationship to total bilirubin, direct bilirubin, aspartic transaminase, urea nitrogen, prothrombin time, prothrombin activity, and international normalized ratio (P<0.01). The cured or survival PQ poisoned patients among the trace PQ group, the low PQ group, the medium PQ group, and the high PQ group were 19/19 (100%), 19/21 (90.47%), 11/25 (44.0%), and 0/25 (0%) respectively. The mean hospital days were (10.37±8.04), (18.76±12.06), (16.76±14.44), and (4.04±5.41) days respectively. The Cox regression analysis indicated that plasma PQ concentration was highly related to prognosis (P<0.05). In conclusion, no patient presenting with a PQ concentration over 5000ng/mL survived. The plasma PQ level is related to liver, kidney and coagulation function, which can be used as an important clinical index to judge the prognosis of PQ poisoned patients.
  Paraquat (PubChem CID: 15938), 5-bromopyrimidine (PubChem CID: 78344), acetonitrile (PubChem CID: 6342), sodium dihydrogen phosphate (PubChem CID: 23672064), sodium heptanesulfonate (PubChem CID: 23672332), methylprednisolone (PubChem CID: 6741), cyclophosphamide (PubChem CID: 2907).
authors.affiliation: Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Guangliang
authors.initials: G
authors.lastname: Hong
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Lufeng
authors.initials: L
authors.lastname: Hu
authors.affiliation: Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Yahui
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Kang
authors.affiliation: Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Guangju
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China. Electronic address: wzlu2014@126.com.
authors.forename: Zhongqiu
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects; D002138:Calibration; D002851:Chromatography, High Pressure Liquid; D004305:Dose-Response Relationship, Drug; D005260:Female; D006464:Hemoperfusion; D006540:Herbicides / Q000097:blood* / Q000506:poisoning*; D006801:Humans; D007677:Kidney Function Tests; D007902:Length of Stay; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000097:blood* / Q000506:poisoning*; D011379:Prognosis; D015203:Reproducibility of Results; D013056:Spectrophotometry, Ultraviolet; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006540:Herbicides; D010269:Paraquat
keywords: HPLC; Paraquat; Patient; Prognosis