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Organophosphate poisoning and related mortality with oxime perfusion

Introduction

A retrospective study performed between 1 January 2001 and 31 October 2006 in patients admitted to the ICU with organophosphate poisoning (OPP). The aim of the study was to determine the relation between mortality and: (a) toxicity of organophosphate, (b) time between ingestion and management of the patient, (c) coligernic manifestations, (d) time and doses of oximes and atropine.

Methods

Were admitted to the ICU 29 patients with OPP. The data were treated by SPSS 14 for Windows and the analysis consisted of a descriptive study, analytic study (chi-square analysis, Spearman association analysis) and comparison between groups (Student t analysis, Wilcoxon Mann–Whitney and Kolmogorov–Smirnov tests). The receiver operating characteristic (ROC) was applied for the Sequential Organ Failure Assessment (SOFA) score.

Results

Twenty-nine patients were included in the study, 21 males and eight females. The mean age of the males was 47.71 years (SD = 13.58) and of females was 41.0 years (SD = 11.66), and 62.7% were from a rural area and 37.3% from an urban area. Mortality does not have a significant statistic relation (P > 0.05) with toxicity of organophosphate, time and doses of atropine. However, statistical significance was found between mortality and: (a) time between ingestion of the poison and treatment (Spearman test, rs = -0.596, P < 0.05), (b) muscarinic manifestations (chi-square test, χ2 = 4.152, P < 0.05), (c) time of oximes (Kolmogorov–Smirnov test with Z = 1.439, P < 0.05) and doses of oximes (Kolmogorov–Smirnov test with Z = 1.412, P < 0.05). The ROC analysis reveals that for the respiratory SOFA at 9 days, the area under the ROC curve was 0.917; this means that this SOFA score can predict correctly in 91.7% of the cases.

Conclusion

In our study we concluded that the mortality rate was increased with prolonged perfusion of oximes and with muscarinic manifestations of OPP but not with the time and dose of atropine. The respiratory SOFA score at 9 days matches with prediction in above 90% of the cases.

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Bartolo, A., Caetano, O., Costa, M. et al. Organophosphate poisoning and related mortality with oxime perfusion. Crit Care 11, P417 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5577

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Keywords

  • Receiver Operating Characteristic
  • Atropine
  • Receiver Operating Characteristic Curve
  • Oxime
  • Association Analysis