Predictors of mortality in acute paraquat poisoning: south indian cohort analysis

Abstract

Background: Acute paraquat poisoning is associated with
high mortality, particularly in agrarian regions of South
Asia. Early identification of prognostic factors is critical for
guiding emergency management in resource-limited
settings.
Methods: This prospective observational cohort study
included 84 consecutive adults with laboratory-confirmed
acute paraquat poisoning presenting to a tertiary care
emergency department in South India. Demographic,
exposure, clinical, and laboratory variables—including
urine dithionite score and PaO₂/FiO₂ ratio—were recorded.
The primary outcome was in-hospital mortality.
Multivariable logistic regression was used to identify
independent predictors.
Results: Overall mortality was 66.7%. Non-survivors had
higher ingestion volumes, longer delays to presentation, and
worse admission parameters. After adjustment, ingestion
>20 mL (OR 8.45; p<0.001), urine dithionite score ≥2 (OR
6.91; p=0.001), and time to emergency department ≥4 hours
(OR 4.82; p=0.004) were the strongest predictors of
mortality. Reduced eGFR <75 mL/min/1.73 m² (OR 3.78;
p=0.012), PaO₂/FiO₂ ratio <290 (OR 3.45; p=0.024), and
CRP >50 mg/L (OR 2.98; p=0.041) were also
independently associated with death.
Conclusion: Acute paraquat poisoning carries high mortality.
Readily available clinical and laboratory parameters may
enable early risk stratification and support timely decisionmaking
in emergency settings, particularly in resourcelimited
environments.

; Herbicide Poisoning;
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