Akut organik fosfor zehirlenmelerinde akut inflamatuar belirteçler, eritrosit kolinesteraz, serum kolinesteraz düzeyi ile mortalite arasındaki ilişki

Amaç: Çalışmada organik fosfor zehirlenmesi olan hastalarda serum ve eritrosit kolinesteraz düzeyi, akut inflamatuvar belirteçler ile mortalite arasındaki ilişkinin araştırılması amaçlanmıştır. Materyal ve Metod : Gereç ve Yöntemler: Acil servise organik fosfor zehirlenmesi ile başvuran 19 kadın, 20 erkek toplam 39 olgu retrospektif olarak değerlendirilmiş olup bu hastalrada serum fibrinojen, ferritin, C reaktif protein, tümör nekroz faktör-alfa, interlökin 1, interlökin 6, interlökin 10, eritrosit ve serum kolinesteraz düzeyleri yanı sıra beyaz küre ve trombosit sayıları gözden geçirilmiştir. Herediter kolinesteraz eksikliği, karaciğer fonksiyon bozukluğu, malnutrisyon, anemi, kokain, morfin, kodein ve süksinilkolin gibi ilaç kullanımı olan olgular çalışmaya alınmamaıştır. Veriler SPSS 18,0 paket programı kullanılarak analiz edilmiştir. Bulgular: Organik fosfor zehirlenmesi nedeniyle ölen hastalarla taburcu edilen hastaların laboratuvar verileri karşılaştırıldığında; ölen hastalarda acile ilk başvuruda alınan ortalama serum kolinesteraz düzeyi düşük (p=0,006), fibrinojen düzeyi yüksek bulunmuştur (p=0,011), Benzer şeklide trombosit sayısı düşük (p=0,031) bulundu. Ancak eritrosit kolinesteraz, IL-1, IL-6, IL-10, TNF-α, CRP, ferritin ve beyaz küre düzeyleri arasında her iki grup arasında istatistiksel olarak anlamlı bir fark bulunamadı. Bun karşın eksitus olan ve taburcu edilen hastaların fibrinojen, eritrosit kolinesteraz (p=0,013) ve serum kolinesteraz (p=0,029) düzeyleri arasında istatistiksel olarak anlamlı bir ilişki saptandı. Sonuç: Organik fosfor zehirlenmesinde serum kolinesteraz düzeyi ve trombosit sayısı düşüklüğü, fibrinojen düzeyi yüksekliğinin mortalite üzerinde etkili faktörler olduğu belirlendi. Acile orgonik fosfor intoksikasyon bulguları ile başvuran olgularda yukarıda sıralanan belirteçler mortalitenin daha önceden öngörülmesi açısından önemli olup daha geniş serilerde yapılacak çalışmalarla bu veriler desteklenmelidir.

Relationship between mortality and acute inflammatory markers, erythrocyte cholinesterase, serum cholinesterase levels in the acute organic phosphorus intoxication

Purpose: In our study, we aimed to investigate the relationship between the mortality and acute inflammatory markers, serum and erythrocyte cholinesterase levels in patients with organophosphorus poisoning. Material and Methods: We included 19 female and 20 male patients who applied to emergency department with organic phosphorus poisoning retrospectively. Standard data entry form has been created. White blood cell (WBC) and platelet counts, fibrinogen, ferritin, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin 6 (IL-6), interleukin 10 (IL-10), erythrocyte and serum cholinesterase levels were determined. Patients with hereditary cholinesterase deficiency, liver disorders, malnourished, anemia, abusing cocaine, morphine, codeine, and medications such as succinylcholine were excluded from the study. SPSS 18.0 software was used for statistical analysis. Results: The laboratory data of patients who died at our hospital due to organophosphorus poisoning were compared with the patients discharged; the mean serum cholinesterase levels of the patients died were statistically low (p = 0.006), platelet counts were also low (p = 0.031), fibrinogen levels were high (p = 0.011). However, there was no statistically significant differences between erythrocyte cholinesterase (p = 0.984), IL-1 (p = 0.139), IL-6 (p = 0.513), IL-10 (p = 0.089), TNF-α (p = 0.074), CRP (p = 0.081), ferritin (p = 0.275), and WBC (p = 0.272) levels of the patients who died or discharged. There was a statistically significant relationship between fibrinogen levels, erythrocyte cholinesterase (p = 0.013), and serum cholinesterase (p = 0.029) levels of the patients who discharged or died. Conclusion: Low serum cholinesterase levels, low platelet count and high fibrinogen levels were found to be significant factors for the high mortality rate of organic phosphorus poisoning. This study will be valuable for emergency physicians to be able to predict mortality of organic phosphorus poisoning thereby contribute more to clinical experiences. These laboratory tests can be used as prognostic markers after more detailed studies.

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