Abstract
Objective
Organophosphate (OP) pesticides are still widely available in developing countries,
leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments
are commonly used in resuscitating OP poisoning patients but few studies regarding
their use have been reported. Our meta-analysis aimed to analyze the efficacy and
outcomes of lipid resuscitation on OP poisoning patients.
Methods
A systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE,
the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected
data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality
rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase
(AchE) level and respiratory function (rate of respiratory muscular paralysis).
Results
Seven randomized controlled studies consisting of 630 patients meeting inclusion criteria
were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI
(1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74),
p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were
lower than those in the control groups [ALT, SMD = −1.52, 95% CI (−2.64, 0.40), p = 0.008;
AST, SMD = −1.66, 95% CI (−3.15, 0.16), p = 0.03; TBIL, SMD = −1.26, 95% CI (−2.32,
0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion
[SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis
was lower in patients undergoing lipid resuscitation than those in the control groups
[OR = 0.19, 95% CI (0.05, 0.71), p = 0.01].
Conclusion
Based on our meta-analysis of included RCT reports, lipid resuscitation seems likely
to help improve prognosis and liver function of OP poisoning patients. However, larger
multi-center RCTs are still recommended.
Keywords
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Article Info
Publication History
Published online: November 17, 2018
Accepted:
November 17,
2018
Received in revised form:
November 13,
2018
Received:
July 26,
2018
Identification
Copyright
© 2018 Published by Elsevier Inc.
