Clinical Profile and Outcomes of Acute Organophosphorus Poisoning Correlated with Serum Cholinesterase Levels And Peradeniya Organophosphorus Poisoning Score: A Cross-Sectional Observational Study At A Tertiary Care Hospital

Abstract

Background: Acute organophosphorus (OP) compound poisoning continues to be an important public health emergency in agricultural India accounting for a large proportion of poisoning deaths. The Peradeniya Organophosphorus Poisoning (POP) score and serum pseudocholinesterase (PChE) are the two indices developed to assess severity of OP poisoning but need to be systematically evaluated for combining the two and predicting the need for mechanical ventilation, intermediate syndrome and death. Methods: This is a cross-sectional observational study that recruited 180 adults with acute OP poisoning who were admitted to a tertiary care hospital during 18-month period. At admission, the POP score, the serum PChE, clinical features, treatment parameters (atropine dose, pralidoxime use), the need for mechanical ventilation, the presence of intermediate syndrome, the length of stay in the ICUs and in-hospital mortality were recorded. Results: The most prevalent compound was chlorpyrifos which accounted for 38.3%. Thirty-two.2% had severe POP score (≥8). Intermediate (14.4%) and mechanical ventilation (36.1%) required and in hospital mortality (9.4%). A negative correlation was shown between serum PChE and severity of POPs (r=−0.62; p<0.001). Independent predictors of mortality were delayed presentation >6 hours, delayed PChE <400 U/L, mechanical ventilation, and POP score ≥8 (all aOR>2.0). Conclusion: The use of the combination of both the POP score and serum PChE at admission in acute OP poisoning allows for good severity stratification. Early intensive care, appropriate atropinisation and oxime therapy, where applicable, are the mainstay of management. There is an emergency need for policy-level regulation of highly toxic OP compounds.