Hyperglycemia at presentation is associated with in hospital mortality in non-diabetic patient with organophosphate poisoning

Abstract

Aims: This study evaluated whether the initial venous glucose level at presentation is associated with fatality in organophosphate (OP)-poisoned patients without diabetes mellitus (DM) and whether the association between glucose and outcome differs depending on the chemical formulation of the OP ingested. Methods: This retrospective observational case series consisted of 184 patients without DM who had a history of OP poisoning. Initial glucose level at presentation, outcome and general clinical data were recorded. The patients were categorized into the following groups according to their glucose level at presentation: group 1 (<140 mg/dl, n = 63), group 2 (140–200 mg/dl, n = 58), group 3 (200–300 mg/dl, n = 41), and group 4 (≥300 mg/dl, n = 22). The most commonly ingested OPs were dichlorvos (n = 33), fenitrothion (n = 25), and ethyl p-nitrophenol thio-benzene phosphonate (EPN) (n = 24). The primary outcome was case fatality. Results: Group 4 had a higher case fatality than groups 1 (p = 0.003) and 2 (p = 0.015), and group 3 had a higher case fatality than group 1 (p = 0.040). Multivariate analysis revealed that age [odds ratio (OR) 1.065, 95% confidence interval (CI) 1.020–1.112, p = 0.001], being in group 3 (OR 6.997, 95% CI 1.063–46.066, p = 0.043) and being in group 4 (OR 9.101, 95% CI 1.380–60.044, p = 0.022) were associated with case fatality. When using the glucose level at presentation > 233 mg/dl, the dichlorvos group had a higher sensitivity (66.7% vs. 50.0%), specificity (90.0% vs. 86.4%), and positive (40.0% vs. 25.0%) and negative (96.4% vs. 95.0%) predictive values for predicting case fatality than the EPN group. No patient died of fenitrothion poisoning (mean glucose level at presentation = 169.4 ± 39.6 mg/dl). Conclusion: The case fatality risk independently increases as the initial venous glucose level at presentation increases in OP-poisoned patients without DM. However, because the association between the venous glucose level at presentation and case fatality varies according to the type of OP ingested, the chemical identity of the OP should be considered.

Keywords:

• Glucose
• organophosphates
• outcome
• pesticide

Acknowledgments

The authors acknowledge Minho Shin and Byeongju Min for their statistical consultation.

Disclosure statement

This work was not supported by any specific project grant from public, commercial, or non-profit funding agencies.