Measurement of Biomarkers and Their Correlations with Mortality in Paraquat and Organophosphate Poisoning

Introduction. Accidental or intentional ingestion of pesticides or herbicides is common in Taiwan because these poisons are easily accessible. Paraquat poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. Acute cholinergic crisis rapidly develops after organophosphate poisoning due to acetylcholinesterase inhibition, and is characterized by signs and symptoms of hyperstimulation of muscarinic receptors (e.g., bradycardia, bronchoconstriction, bronchorrhea, hypotension, increased gastrointestinal motility, abdominal cramps, miosis, hypersalivation), nicotinic receptors (e.g., hypertension, tachycardia, fibrillation, fasciculation, necrosis of striated muscles), and both central muscarinic and nicotinic receptors (e.g., tremor, movement incoordination, seizures, central depression of respiration, coma, death). Objectives: We attempt to investigate the utility of laboratory biomarkers, for example pro-inflammatory cytokines or endothelial progenitor cell as predictors of outcome in patients with paraquat or organophosphate poisoning. Furthermore, we will develop an innovative paper-based ELISA technique, and will compare this paper-based with conventional ELISA technique in diagnosing paraquat or organophosphate poisoning. Methods. In year one and two, we will prospectively identify all patients with acute paraquat or organophosphate exposure presenting to Chang Gung Memorial Hospital. All patients will receive standard detoxification protocols, supportive care, including intravenous fluids and ventilatory and hemodynamic support as required. In addition to the routine practice, written informed consent will be obtained for the collection of additional biologic samples (e.g. blood and urine). The demographic, clinical, laboratory, and mortality data will be obtained for analysis. In year two, apart from the biomarker study, we will develop a paper-based ELISA technique for paraquat or organophosphate poisoning, and will check the sensitivity and specificity of this analysis, as well as compare with conventional ELISA system. Expected results. In the first part of this study (year one and two), it is possible that the expression patterns of cytokines or endothelial progenitor cell may help discriminate between patients who have poor chance of survival and those who may potentially benefit from interventions. This finding has practical prognostic implications. In the second part of this study (year two), we expect that the paper-based ELISA technique could be faster and cheaper than conventional method, but the sensitivity and specificity needs clinical verification.

Project ID:PC10207-0827
External Project ID:NSC102-2314-B182A-121