Hemoperfusion in Combination with Hemofiltration for Acute Severe Organophosphorus Pesticide Poisoning: A Systematic Review and Meta-analysis

Overview

Journal J Res Med Sci

Specialty General Medicine

Date 2022 May 13

PMID 35548179

Authors

Minghao Zhang

Wei Zhang

Shunzhong Zhao

Xiaoxi Tian

Guoqiang Fu

Boliang Wang

Affiliations

Soon will be listed here.

Abstract

Background: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP.

Materials And Methods: A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1.

Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], < 0.001), total atropine dosing (WMD -147.34 mg, 95% CI [-199.49, -95.18], < 0.001), duration of mechanical ventilation (WMD -2.34 days, 95% CI [-3.77, -0.92], < 0.001), cholinesterase recovery time (WMD -2.49 days, 95% CI [-3.14, -1.83], < 0.001), and length of stay (WMD -4.52 days, 95% CI [-5.31, -3.73], < 0.001).

Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.

Citing Articles

Influence of sequential blood purification therapy on myocardial injury and serum inflammatory cytokine levels in patients with organophosphate poisoning.

Mao P, Li J, Li B, Su Z, Wu B, Li Y Am J Transl Res. 2024; 16(10):6041-6051.

PMID: 39544734 PMC: 11558392. DOI: 10.62347/FYHC6091.

References

Ghannoum M, Hoffman R, Gosselin S, Nolin T, Lavergne V, Roberts D . Use of extracorporeal treatments in the management of poisonings. Kidney Int. 2018; 94(4):682-688. DOI: 10.1016/j.kint.2018.03.026. View

Liu L, Ding G . Effects of different blood purification methods on serum cytokine levels and prognosis in patients with acute severe organophosphorus pesticide poisoning. Ther Apher Dial. 2014; 19(2):185-90. DOI: 10.1111/1744-9987.12233. View

Gil H, Kim S, Yang J, Lee E, Hong S . Clinical outcome of hemoperfusion in poisoned patients. Blood Purif. 2010; 30(2):84-8. DOI: 10.1159/000318585. View

Kang E, Seok S, Lee K, Gil H, Yang J, Lee E . Factors for determining survival in acute organophosphate poisoning. Korean J Intern Med. 2009; 24(4):362-7. PMC: 2784981. DOI: 10.3904/kjim.2009.24.4.362. View

Bajracharya S, Prasad P, Ghimire R . Management of Organophosphorus Poisoning. J Nepal Health Res Counc. 2017; 14(34):131-138. View

Fujii T, Ganeko R, Kataoka Y, Furukawa T, Featherstone R, Doi K . Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2017; 44(2):167-178. DOI: 10.1007/s00134-017-5004-9. View

Acikalin A, Disel N, Matyar S, Sebe A, Kekec Z, Gokel Y . Prognostic Factors Determining Morbidity and Mortality in Organophosphate Poisoning. Pak J Med Sci. 2017; 33(3):534-539. PMC: 5510098. DOI: 10.12669/pjms.333.12395. View

Holubek W, Hoffman R, Goldfarb D, Nelson L . Use of hemodialysis and hemoperfusion in poisoned patients. Kidney Int. 2008; 74(10):1327-34. DOI: 10.1038/ki.2008.462. View

Huedo-Medina T, Sanchez-Meca J, Marin-Martinez F, Botella J . Assessing heterogeneity in meta-analysis: Q statistic or I2 index?. Psychol Methods. 2006; 11(2):193-206. DOI: 10.1037/1082-989X.11.2.193. View

10.

Propadalo I, Tranfic M, Vuka I, Barcot O, Poklepovic Pericic T, Puljak L . In Cochrane reviews, risk of bias assessments for allocation concealment were frequently not in line with Cochrane's Handbook guidance. J Clin Epidemiol. 2018; 106:10-17. DOI: 10.1016/j.jclinepi.2018.10.002. View

11.

Lin L, Chu H . Quantifying publication bias in meta-analysis. Biometrics. 2017; 74(3):785-794. PMC: 5953768. DOI: 10.1111/biom.12817. View

12.

Mojsak P, Lozowicka B, Kaczynski P . Estimating acute and chronic exposure of children and adults to chlorpyrifos in fruit and vegetables based on the new, lower toxicology data. Ecotoxicol Environ Saf. 2018; 159:182-189. DOI: 10.1016/j.ecoenv.2018.05.006. View

13.

Delgado-Rodriguez M, Sillero-Arenas M . Systematic review and meta-analysis. Med Intensiva (Engl Ed). 2017; 42(7):444-453. DOI: 10.1016/j.medin.2017.10.003. View

14.

Eddleston M . Are Oximes Still Indicated for Acute Organophosphorus Insecticide Self-Poisoning?. J Med Toxicol. 2018; 14(1):1-2. PMC: 6013733. DOI: 10.1007/s13181-018-0651-y. View

15.

Nasr Isfahani S, Farajzadegan Z, Sabzghabaee A, Rahimi A, Samasamshariat S, Eizadi-Mood N . Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis. J Res Med Sci. 2019; 24:2. PMC: 6383336. DOI: 10.4103/jrms.JRMS_478_18. View

16.

Marquart K, Prokopchuk O, Worek F, Thiermann H, Martignoni M, Wille T . Human small bowel as a useful tool to investigate smooth muscle effects of potential therapeutics in organophosphate poisoning. Toxicol Lett. 2017; 293:235-240. DOI: 10.1016/j.toxlet.2017.11.012. View

17.

Altintop L, Aygun D, Sahin H, Doganay Z, Guven H, Bek Y . In acute organophosphate poisoning, the efficacy of hemoperfusion on clinical status and mortality. J Intensive Care Med. 2005; 20(6):346-50. DOI: 10.1177/0885066605279834. View

18.

Si X, Li J, Bi X, Wu L, Wu X . Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome. PLoS One. 2015; 10(7):e0132708. PMC: 4514858. DOI: 10.1371/journal.pone.0132708. View

19.

Ghannoum M, Bouchard J, Nolin T, Ouellet G, Roberts D . Hemoperfusion for the treatment of poisoning: technology, determinants of poison clearance, and application in clinical practice. Semin Dial. 2014; 27(4):350-61. DOI: 10.1111/sdi.12246. View

20.

cadez T, Kolic D, Sinko G, Kovarik Z . Assessment of four organophosphorus pesticides as inhibitors of human acetylcholinesterase and butyrylcholinesterase. Sci Rep. 2021; 11(1):21486. PMC: 8563940. DOI: 10.1038/s41598-021-00953-9. View