Clinical correlates of hypotension in patients with acute organophosphorus poisoning

doi:10.5847/wjem.j.1920-8642.2021.01.004

Abstract

Abstract:

BACKGROUND: The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning (AOPP).

METHODS: In this retrospective cohort study, we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals. Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension. We also evaluated the association between clinical parameters (including hypotension) and in-hospital mortality.

RESULTS: The incidence of hypotension in AOPP patients was 16.4%. Hypotensive patients showed significantly higher in-hospital mortality (1.1% vs. 39.9%, P<0.001). Advanced age (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.08-1.44), history of diabetes (OR 2.65, 95% CI 1.14-5.96), and increased white blood cell count (OR 1.06, 95% CI 1.03-1.09), plasma cholinesterase (OR 0.91, 95% CI 0.84-0.94), plasma albumin (OR 0.88, 95% CI 0.85-0.92), serum amylase (OR 1.01, 95% CI 1.01-1.02), and blood pH (OR 0.64, 95% CI 0.54-0.75) were significantly associated with hypotension. After adjusting for potential confounders, hypotension was associated with increased in-hospital mortality (hazard ratio 8.77-37.06, depending on the controlled variables).

CONCLUSIONS: Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality. Advanced age, history of diabetes, and changes in laboratory parameters were associated with hypotension in AOPP patients.

Key words: Acute organophosphate poisoning, Hypotension, Cholinesterase inhibitor, Cardiovascular complication, Shock

Ning Dong, Zhe-xi Lu, Xing-liang Li, Wei Li, Li Pang, Ji-hong Xing. Clinical correlates of hypotension in patients with acute organophosphorus poisoning[J]. World Journal of Emergency Medicine, 2021, 12(1): 24-28.

Figures/Tables 3

Table 1

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Variables	Overall (n=871)	No hypotension (n=728)	Hypotension (n=143)	P-value
Age (years), median (25^th-75^thpercentile)	44.0 (32.5-56.0)	43.0 (32.0-54.0)	50.0 (35.0-66.0)	<0.001
Male, n (%)	439 (50.4)	358 (49.2)	81 (56.6)	0.123
Past medical history, n (%)
Hypertension	57 (6.5)	43 (5.9)	14 (9.8)	0.096^*
Diabetes	44 (5.1)	29 (4.0)	15 (10.5)	0.002
COPD	7 (0.8)	3 (0.5)	4 (2.1)	0.016^*
Liver cirrhosis	3 (0.3)	2 (0.3)	1 (0.7)	0.417^*
CKD	7 (0.8)	4 (0.5)	3 (2.1)	0.092^*
Laboratory test, median (25^th-75^thpercentile)
pChE (U/L)	554 (295-1,460)	692 (317-1,659)	302 (193-521)	<0.001
White blood cells (×10⁹/L)	13.8 (9.5-18.6)	13.3 (9.2-17.7)	16.6 (11.3-22.8)	<0.001
Albumin (g/L)	39.9 (35.9-43.5)	40.6 (37-43.9)	34.3 (29.4-39.6)	<0.001
Amylase (U/L)	104.0 (63.0-248.0)	91.5 (57.0-183.0)	248.0 (137.5-544.5)	<0.001
Blood pH	7.37 (7.31-7.43)	7.39 (7.34-7.43)	7.26 (7.15-7.34)	<0.001
Lactic acid (mmol/L)	1.5 (0.9-3.1)	1.4 (0.9-2.7)	2.5 (1.1-5.2)	<0.001
Cardiac arrest, n (%)	13 (1.5)	4 (0.5)	9 (6.3)	<0.001
Hemoperfusion, n (%)	476 (54.6)	353 (48.5)	123 (86.0)	<0.001
Ventilation, n (%)	149 (17.1)	39 (5.4)	110 (76.9)	<0.001
Mortality, n (%)	65 (7.5)	8 (1.1)	57 (39.9)	<0.001

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