| BackgroundDiquat(DQ)has been widely used in agricultural production as a substitute for paraquat,since paraquat was prohibited from being sold and used in China.At the same time,the number of acute DQ poisoning cases increased gradually.Acute DQ poisoning has become a common disease in Chinese emergency departments.Although the World Health Organization announced in 2020 that DQ was moderately toxic,the case fatality rate of acute DQ poisoning was as high as 16.7%～60.0%.At present,the poisoning mechanism of DQ is not clear,and there is no specific antidote.Therefore,it is very important to determine the relevant factors affecting the severity and prognosis of acute DQ-poisoned patients.Animal studies have shown that interleukin-1β(IL-1β),interleukin-2R(IL-2R),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),and tumor necrosis factor-a(TNF-α)are closely related to acute DQ poisoning.Therefore,the study combined with the specific situation of poisoned patients admitted to Qilu hospital of Shandong university to explore the influence of cytokines IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α on the severity and prognosis of acute DQ poisoning.Purpose1.To analyze the influences of IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α on the prognosis of acute DQ-poisoned patients.2.To analyze the correlation of IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α with the severity of acute DQ-poisoned patients.Materials and MethodsA retrospective study was conducted on 132 patients with acute DQ poisoning.These patients were treated at the Emergency Department between December 1,2021,to August 31,2022.Upon arrival at the emergency room,we collected the general data and laboratory test results of patients conforming to the standard.1.Acute DQ-poisoned patients conforming to the standard were divided into survivors and non-survivors.And the general data and cytokines were compared between the two groups.Univariate analysis and multivariate cox proportional hazards model(Cox)regression analysis were used to analyze the independent risk factors affecting the prognosis of acute DQ poisoning.And the receiver operating characteristic(ROC)curve was drawn to analyze its predictive value.The kaplan-meier(KM)survival curve was used to compare the survival rate of patients with different cytokine concentrations.2.According to expert consensus,the oral DQ dose divided acute DQ-poisoned patients into mild,moderate,and severe poisoning groups.The Spearman correlation analysis was used to analyze the correlation between cytokines and severity.Results1.A total of 132 acute DQ-poisoned patients were included in this study,including 65 males(49.24%)and 67 females(50.76%),with an average age of(29.19±13.97)years.According to the prognosis within 28 days of poisoning,they were divided into survivors(80 cases,60.61%)and non-survivors(52 cases,30.39%).And the included patients were divided into a mild poisoning group(36 cases,27.27%),a moderate poisoning group(63 cases,47.73%),and a severe poisoning group(33 cases,25.00%)by the oral dose.2.The results of univariate analysis showed that age,oral dose,white blood cell,alanine aminotransferase,creatinine,creatine kinase-MB,Lipase,IL-1β,IL-2R,IL-6,IL-8,IL-10 and TNF-α between survivors and non-survivors were significantly different(P<0.05).There were statistical differences in IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α concentrations between survivors and non-survivors on day 1 and day 3(P<0.05).There were significant differences in IL-2R,IL-6,IL-8,IL-10 and TNF-α concentrations on day 7(P<0.001).3.Multivariate Cox regression analysis showed that oral dose(HR=1.011,95%CI=1.008-1.015,P<0.001),IL-6(HR=1.000,95%CI=1.000-1.001,P=0.002),IL-8(HR=1.000,95%CI=1.000-1.001,P=0.006),and IL-10(HR=1.001,95%CI=1.000-1.002,P=0.026)were independent risk factors for the prognosis of acute DQ-poisoned patients within 28 days.4.ROC curve analysis results showed that the areas under the curve of IL-6,IL-8,and IL-10 to predict the 28-day prognosis of DQ-poisoned patients were respectively 0.879(95%CI=0.823-0.935),0.831(95%CI=0.7633-0.899),and 0.867(95%CI=0.801-0.933).5.KM curve analysis showed that acute DQ-poisoned patients with an increased IL-6 level of 11.20pg/mL or higher showed a higher risk of death than those patients with normal IL-6 level during the 28-day follow-up period(χ2=50.556,P<0.001).Patients with an increased IL-8 level of 18.75pg/mL or higher showed a higher risk of death than those patients with normal IL-8 level during the 28-day follow-up period(χ2=43.111,P<0.001).And patients with an increased IL-10 level of 7.98pg/mL or higher showed a higher risk of death than those patients with normal IL-10 level during the 28-day follow-up period(χ2=55.180,P<0.001).6.The Spearman correlation analysis showed that the concentration levels of IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α were positively correlated with the severity of acute DQ poisoning(P<0.01).Conclusions1.The higher the concentration levels of IL-1β,IL-2R,IL-6,IL-8,IL-10,and TNF-α,the more serious the severity of acute DQ poisoning.2.IL-6,IL-8,and IL-10 can predict the risk of death in acute DQ-poisoned patients to a certain extent.3.IL-6>11.20pg/mL,IL-8>18.75pg/mL,and IL-10>7.98pg/mL on admission suggested a worse prognosis. |
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