Leveraging plasma concentrations to optimize extracorporeal treatment in acute diquat poisoning: a multi-center retrospective cohort study.

INTRODUCTION

Diquat poisoning is common in Asia and the optimal enhanced elimination strategy is unknown. This study aimed to evaluate the clinical value of plasma diquat concentrations in guiding personalized extracorporeal treatment regimens for patients with acute diquat poisoning.

METHODS

This multi-center retrospective cohort study included 163 patients with acute diquat poisoning admitted between February 2022 and July 2023. Patients were divided into three groups based on plasma diquat concentrations measured upon presentation to the emergency department: low (<100 μg/L), medium (100-1,000 μg/L), and high (≥1,000 μg/L). The evaluated extracorporeal treatment regimens included hemoperfusion alone and a combination of hemoperfusion with continuous veno-venous hemodiafiltration. Kaplan-Meier survival curves were used to estimate cumulative survival probabilities, with survival probabilities compared using log-rank tests.

RESULTS

All 66 patients survived in the low concentration group, regardless of the extracorporeal treatment used. In the medium and high concentration groups, five patients who refused extracorporeal treatment died, whereas 92 patients who received extracorporeal treatment had a case fatality rate of 48.9%. In the high concentration group, patients receiving hemoperfusion combined with continuous veno-venous hemodiafiltration had a case fatality rate of 76.7% and better survival probabilities, compared to hemoperfusion-only patients, which had no survivors. Additionally, among those treated with a combination of hemoperfusion and continuous veno-venous hemodiafiltration, the time interval from the end of hemoperfusion session to the initiation of continuous veno-venous hemodiafiltration was, on average, shorter for survivors than deaths (3.7 h versus 4.7 h).

DISCUSSION: This retrospective observational study of diquat poisoned patients highlights the potential for personalized extracorporeal treatment regimens using an initial plasma diquat concentration. Future randomized trials are warranted to evaluate the optimal use of extracorporeal treatments.

CONCLUSION

Obtaining plasma diquat concentrations may be of great value for guiding extracorporeal treatment regimens to improve prognosis in patients with acute diquat poisoning.