Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning: A systematic review and meta?analysis
Abstract
Background: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and
health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and
cholinesterase reactivators were uncertain. This meta?analysis aims to investigate the safety and efficacy of hemoperfusion combined
with hemofiltration besides routine therapy for ASOPP. Materials and Methods: A comprehensive search for candidate publications
was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National
Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion
and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD)
were pooled for categorical variables and continuous variables, respectively. Meta?analyses and publication bias were conducted by
using STATA software version 15.1. Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD ?147.34 mg, 95% CI [?199.49, ?95.18], P < 0.001), duration of mechanical ventilation (WMD ?2.34 days, 95% CI [?3.77, ?0.92], P < 0.001), cholinesterase recovery time (WMD ?2.49 days, 95% CI [?3.14, ?1.83], P < 0.001), and length of stay (WMD ?4.52 days, 95% CI [?5.31, ?3.73], P < 0.001). Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.
health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and
cholinesterase reactivators were uncertain. This meta?analysis aims to investigate the safety and efficacy of hemoperfusion combined
with hemofiltration besides routine therapy for ASOPP. Materials and Methods: A comprehensive search for candidate publications
was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National
Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion
and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD)
were pooled for categorical variables and continuous variables, respectively. Meta?analyses and publication bias were conducted by
using STATA software version 15.1. Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD ?147.34 mg, 95% CI [?199.49, ?95.18], P < 0.001), duration of mechanical ventilation (WMD ?2.34 days, 95% CI [?3.77, ?0.92], P < 0.001), cholinesterase recovery time (WMD ?2.49 days, 95% CI [?3.14, ?1.83], P < 0.001), and length of stay (WMD ?4.52 days, 95% CI [?5.31, ?3.73], P < 0.001). Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.
Keywords
Hemofiltration, hemoperfusion, meta?analysis, mortality, organophosphorus poisoning