Mortality Analysis of Patients with Paraquat Poisoning Treated at Two University Hospitals in Shiraz, Iran

Background: Poisoning with paraquat (PQ) is highly fatal. In this study; demographic and clinical characteristics of  a series of patients with acute PQ poisoning treated at two university hospitals in Shiraz, Iran are presented and predictive factors for mortality are analyzed. Methods: This was an analytical cross-sectional study on consecutive PQ poisoned patients admitted to Shoushtari and Ali Asghar hospitals in Shiraz, Iran during 21st March 2012 to 20th March 2013. To find out predictive factors for mortality, independent variables were compared between death and survival using Fisher’s exact test. To determine the factors that had the strongest impact on mortality, logistic regression analysis was done. Results: Fifty-two patients (73.1% men) were included with mean age of 28.2 ± 10.3 years. The most common clinical findings were nausea and vomiting (88.5%), pharyngeal congestion (82.7%), epigastric pain (80.8%), increased creatinine (57.7%), increased liver enzymes (53.8%) and metabolic acidosis (53.8%). The volume of poison ingested was significantly higher in deceased compared to survived patients (P < 0.001). Death was significantly higher in patients with pharyngeal congestion (P = 0.001), respiratory distress (P < 0.001), loss of consciousness (P = 0.025), increased creatinine (P < 0.001), increased liver enzymes (P < 0.001), metabolic acidosis (P < 0.001), increased bilirubin (P < 0.001), respiratory acidosis (P = 0.001), increased INR (P = 0.023), suicidal intention (P < 0.001), and oral exposure (P = 0.047). After putting these factors to logistic regression model, only respiratory distress, increased bilirubin, increased liver enzymes and increased creatinine continued to be significantly associated with mortality. Conlcusion: PQ poisoning is associated with high mortality requiring an immediate assessment of patients and prediction of prognosis. Renal and hepatic failure in addition to respiratory distress can be the strongest risk factors for poor prognosis in acute PQ poisoning.