Association between liberal oxygen therapy and mortality in patients with paraquat poisoning: A multi-center retrospective cohort study

• Published in: PloS one Vol. 16; no. 1; p. e0245363
• Main Authors: Lin, Xin-Hong, Pan, Hsiu-Yung, Cheng, Fu-Jen, Huang, Kuo-Chen, Li, Chao-Jui, Chen, Chien-Chih, Chuang, Po-Chun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15-01-2021; Public Library of Science (PLoS)
• Subjects: Adenine; Age; Biology and Life Sciences; Blood levels; Care and treatment; Cohort analysis; Complications and side effects; Confidence intervals; Creatinine; Cytochrome; Cytochrome P450; Cytochromes P450; Developing countries; Dichlorides; Editing; Electronic mail; Emergency medical care; Emergency medical services; Emergency medicine; Health aspects; Herbicides; Hospitals; Hypoxia; Intoxication; Intubation; LDCs; Medical schools; Medicine; Medicine and Health Sciences; Methods; Mortality; NADPH-cytochrome P450 reductase; NADPH-diaphorase; NADPH-ferrihemoprotein reductase; Nicotinamide; Nicotinamide adenine dinucleotide; Nitric oxide; Nitric-oxide synthase; Normal distribution; Oxygen; Oxygen therapy; Paraquat; Patient outcomes; Patients; Physical Sciences; Poisoning; Reductases; Regression analysis; Risk analysis; Risk factors; Statistical analysis; Urine; Vital signs; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0245363

Paraquat (N, N'-dimethyl-4, 4'-bipyridinium dichloride, PQ) intoxication is a common cause of lethal poisoning. This study aimed to identify the risk of using liberal oxygen therapy in patients with PQ poisoning. This was a multi-center retrospective cohort study involving four medical institutions in Taiwan. Data were extracted from the Chang Gung Research Database (CGRD) from January 2004 to December 2016. Patients confirmed to have PQ intoxication with a urine PQ concentration ≥ 5 ppm were analyzed. Patients who received oxygen therapy before marked hypoxia (SpO2 ≥ 90%) were defined as receiving liberal oxygen therapy. The association between mortality and patient demographics, blood paraquat concentration (ppm), and liberal oxygen therapy were analyzed. A total of 416 patients were enrolled. The mortality rate was higher in the liberal oxygen therapy group (87.8% vs. 73.7%, P = 0.007), especially in 28-day mortality (adjusted odds ratio [aOR]: 4.71, 95% confidence interval [CI]: 1.533-14.471) and overall mortality (aOR: 5.97, 95% CI: 1.692-21.049) groups. Mortality in patients with PQ poisoning was also associated with age (aOR: 1.04, 95% CI: 1.015-1.073), blood creatinine level (aOR: 1.49, 95% CI: 1.124-1.978), and blood paraquat concentration (ppm) (aOR, 1.51; 95% CI: 1.298-1.766). Unless the evidence of hypoxia (SpO2 < 90%) is clear, oxygen therapy should be avoided because it is associated with increased mortality.