Background: Paraquat is a highly toxic herbicide that frequently causes multiorgan failure and death. In many resource-limited settings, hemodialysis is the only available extracorporeal modality, and the impact of its timing on survival remains uncertain. We evaluated whether the timing of hemodialysis initiation (Day 1 vs Days 2-3) is associated with in-hospital survival in acute paraquat poisoning.
Methods: We conducted a single-center prospective cohort study of 100 consecutive patients with confirmed paraquat ingestion admitted to a tertiary hospital in West Bengal, India. Patients were categorized by hemodialysis timing: early (Day 1) or delayed (Days 2-3). Continuous variables were compared using Mann-Whitney tests and categorical variables using χ2 or Fisher's exact tests. Multivariable logistic regression, including age, sex, respiratory distress, serum bilirubin, creatinine at presentation, and timing of hemodialysis, was used to identify independent predictors of survival. Survival was further evaluated with Kaplan-Meier curves and the log-rank test.
Results: Baseline demographic, clinical, and laboratory features were similar between early and delayed hemodialysis groups (n = 50 each). Overall, 21 patients (21 %) survived to discharge. Survival was higher with early hemodialysis (15/50, 30 %) than with delayed hemodialysis (6/50, 12 %; p = 0.048). Early hemodialysis was independently associated with increased odds of survival (adjusted OR 3.44, 95 % CI 1.07-11.09, p = 0.038). Absence of respiratory distress strongly predicted survival (adjusted OR 16.18, 95 % CI 1.97-132.99, p = 0.010).
Conclusion: In this cohort, hemodialysis initiated on Day 1 after paraquat ingestion was independently associated with improved in-hospital survival compared with initiation on Days 2-3.
Keywords: Acute kidney injury; Hemodialysis; Hemoperfusion; Jaundice; Paraquat; Respiratory failure; Survival.
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