Efficacy of haemoperfusion therapy in patients with paraquat poisoning: a meta-analysis

Paraquat (PQ) poisoning is a public health concern because there is no specific antidote. The effect of haemoperfusion (HP) in clearance of plasma PQ is conflict. The aim of this study is to determine the efficacy and safety of HP therapy in paraquat-poised patients. Bibliographic literature searches were conducted in PubMed, Web of Science and CNKI databases. Pooled data were analyzed by calculating relative risk ratios (RRs) with 95% confidence intervals (CIs), and mean differences (MDs) with 95% CIs for continuous outcomes. The outcomes included mortality, incidence of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS), the levels of alanine transaminase (ALT), partial pressure of oxygen (PaO2), aspartate aminotransferase (AST), creatinekinase (CK), creatinekinase-MB (CK-MB) and Cr (creatinine). Forty-three studies met the inclusion criteria, including 1291 patients in the experimental group and 1026 patients in the control group. HP therapy significantly reduced the mortality of patients with PQ poisoning (RR = 0.60; 95% CI = 0.54-0.66) compared with conservative treatment. Furthermore, HP therapy significantly decreased the occurrence of ARDS and MODS; and lowered the levels of AST, CK, CK-MB and Cr, while there was no statistical difference in ALT and PaO2. Besides, comparing with traditional HP, we found that intensive HP therapy reduced the mortality of patients with PQ poisoning (RR = 0.79; 95% CI = 0.68-0.91). In conclusion, HP therapy significantly reduced the mortality of patients with PQ poisoning, and intensive HP therapy had a better effect than traditional HP.