Startseite Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning
Artikel Open Access

Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning

  • Yuhang Mu , Boqi Hu , Nan Gao und Li Pang EMAIL logo
Veröffentlicht/Copyright: 15. Juli 2021

Abstract

This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

1 Introduction

Organophosphate pesticides (OPs) have been widely used for controlling agricultural and forestry pests worldwide since the 1930s because of their strong insecticidal effect and low cost. However, acute OP poisoning (AOPP) is a significant problem and a potential cause of mortality in the developing world, especially in Asian countries, because of the lack of regulation and easy availability of these products [1].

AOPP progresses rapidly. Disease severity is evaluated based on symptoms and routine laboratory tests. Typical symptoms include salivation, sweating, pupil constriction, and muscle fibrillation. Critically ill patients present respiratory failure, disturbance of consciousness, shock, and death. However, initial symptoms are not detected in the emergency room in many patients because of prompt first aid.

Some indicators of the severity of AOPP have been identified. For instance, the determination of cholinesterase (ChE) levels in the plasma of AOPP patients is widely used in clinical diagnosis, treatment, and prognosis. In addition, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores are positively correlated with disease severity and serve as a prognostic marker in adult AOPP patients admitted to the ICU [2]. Blood lactate level is a good indicator of perfusion status, and hyperlactatemia is associated with increased case fatality rates [3]. Furthermore, caspase [4], serum amylase [5], and other markers [6,7,8] have been used to predict the prognosis of patients with OP poisoning. However, these scoring systems are complex and not widely applied in clinical practice because of hospital limitations. Therefore, it is crucial to identify simple, reliable, and easily obtainable clinical markers to assess the severity and prognosis of patients with AOPP.

The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of short- and long-term mortality in critically ill patients, and measurement is simple, cheap, and fast [9]. Furthermore, the NLR is a powerful prognostic predictor of cardiovascular disease, cancer, acute ischemic stroke, and other diseases [10,11,12,13,14]. This study evaluates the prognostic value of NLR in AOPP.

2 Materials and methods

2.1 Study design and data collection

This retrospective cohort study was conducted at First Hospital of Jilin University from January 1, 2013, to December 31, 2018. A questionnaire containing the following variables was used: age, gender, medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease [COPD], chronic kidney disease [CKD], and liver cirrhosis), blood tests (white blood cell count, hematocrit, platelet count, plasma cholinesterase [pChE], urea nitrogen, serum creatinine, serum amylase, and albumin), and blood gas analysis (pH, partial pressure of oxygen and carbon dioxide, base excess, and lactate) within 24 h after hospital admission. These data were collected by two experienced physicians and transferred to Excel spreadsheets. The data were anonymized.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration and has been approved by the Research Ethics Committee of the First Hospital of Jilin University.

2.2 Diagnosis of AOPP

AOPP was defined as oral exposure to OPs and pChE values lower than 4,300 U/L at admission.

2.3 Inclusion and exclusion criteria and outcomes

The inclusion criteria were as follows: age >18 years, oral exposure to OPs, and hospital admission within 24 h after exposure. The exclusion criteria were as follows: exposure to medications or toxic chemicals other than OPs, patients with normal pChE levels, and patients with severe chronic comorbidities, including liver cirrhosis, symptomatic heart failure (New York Heart Association class III or IV), end-stage CKD (on regular hemodialysis), and COPD.

Outcomes were in-hospital mortality and severe AOPP, and the latter was characterized by ventilatory support; hypotension or shock and the need for dopamine or norepinephrine to maintain hemodynamic stability; and cardiac arrest or death.

2.4 Statistical analysis

Continuous variables were expressed as medians (IQR) and were compared using the Kruskal–Wallis test. Categorical variables were expressed as numbers (proportions) and were compared using the chi-square test or Fisher’s exact test. The confounding effects of demographic characteristics, medical history, and laboratory test results on severe AOPP and in-hospital mortality were evaluated using univariate logistic regression and backward stepwise multivariate logistic regression. Multicollinearity was checked using variance inflation factors. The prognostic value of NLR in AOPP was analyzed by the area under the receiver operating characteristic curve (AUC). The optimal cutoff for NLR was estimated using the Youden index. A two-tailed p-value of less than 0.05 was considered to be statistically significant. All analyses were performed using R software version 3.6.0 (R Foundation for Statistical Computing, Vienna, Austria).

3 Results

3.1 Baseline characteristics

A total of 523 patients were identified retrospectively from a hospital database. Of whom, 138 (26.4%) were excluded because of exposure to toxic chemicals other than OPs (38, 7.3%), admission after 24 h of exposure (49, 9.4%), normal pChE on admission (10, 1.9%), COPD (2, 0.4%), decompensated liver cirrhosis (2, 0.4%), or missing laboratory data (37, 7.1%). Data from 385 AOPP patients were included in the analysis. The flowchart of patient selection is shown in Figure 1. The percentage of severe cases and overall mortality was 23.6 and 7.3%, respectively. The median NLR was 11.8 (7.35–19.49). Patients were further divided into three groups according to NLR values: <12.0, 12.0–23.9, and ≥24.0. Baseline characteristics according to NLR levels are shown in Table 1. The rate of diabetes, number of neutrophils and lymphocytes, pChE, amylase, pH, lactate, number of patients with AOPP, and in-hospital mortality were significantly different across these three groups (Table 1).

Figure 1 
                  Patient selection.
Figure 1

Patient selection.

Table 1

Baseline characteristics according to the neutrophil-to-lymphocyte ratio

L-NLR M-NLR H-NLR p-value
(NLR ≤ 12) (12 < NLR ≤ 24) (NLR > 24)
Patients 196 128 61
Age (years) 42 (33–51) 43 (33–58) 13 (30–60) 0.363
Gender, M/F 100/96 65/63 29/32 0.888
Hypertension, n (%) 14 (7.1) 9 (7.0) 6 (9.8) 0.759
Diabetes, n (%) 4 (2.0) 8 (6.3) 7 (11.5) 0.009
Clinical data
Neutrophil 8.7 (5.8–12.8) 15.3 (12.3–19.6) 16.9 (14.2–21.7) <0.001
Lymphocyte 1.5 (1.1–1.8) 0.9 (0.7–2.5) 0.5 (0.4–0.7) <0.001
pChE 565 (282–1596) 378 (255–1256) 321 (217–776) 0.018
Amylase 91.5 (57.8–176.0) 150 (79.0–317.0) 150 (88.0–330.0) <0.001
sCr 0.65 (0.55–0.81) 0.68 (0.58–0.85) 0.69 (0.59–0.88) 0.32
pH 7.4 (7.34–3.45) 7.37 (7.29–7.42) 7.35 (7.27–7.41) <0.001
Lactate 1.3 (0.8–2.4) 1.6 (1.0–3.5) 1.6 (1.0–3.0) 0.03
Complications
Ventilatory support 7 (5.4) 39 (30.5) 32 (52.5) <0.001
Shock 6 (4.7) 43 (33.6) 31 (50.8) <0.001
Cardiac arrest 0 1 (0.8) 3 (4.9) 0.006
Outcomes
Severe poisoning 7 (3.6) 50 (39.1) 34 (55.7) <0.001
Death 4 (2.0) 13 (10.2) 11 (18.0) <0.001

NLR, neutrophil-to-lymphocyte ratio; pChE, plasma cholinesterase; sCr, serum creatinine.

3.2 NLR as indicators of severe poisoning and in-hospital mortality in AOPP patients

The results of the univariate logistic regression analysis are shown in Table 2. Variables with p-values of less than 0.2 were included in multivariate logistic regression models. After backward stepwise logistic regression, the adjusted odds ratio (AOR) of NLR was 1.13 (1.10–1.17, p < 0.001) and 1.07 (1.03–1.11, p < 0.001) for severe AOPP and in-hospital mortality, respectively (Table 3). No multicollinearity was detected in the multivariate models (Appendix Table A1). The AUC of NLR for discriminating severe poisoning and in-hospital mortality was 0.83 (95% CI, 0.79–0.89) and 0.75 (95% CI, 0.66–0.84), respectively, and the optimal cutoff for predicting these events was 13 and 17, respectively. The AUC of NLR >13 for discriminating severe poisoning was 0.78 [95% CI, 0.74–0.82], with a sensitivity of 0.89 and specificity of 0.67. The AUC of NLR >17 for discriminating death was 0.71 [95% CI, 0.63–0.80], with a sensitivity of 0.71 and specificity of 0.71 (Figure 2 and Table 4). The AUCs of pChE, amylase, serum creatine, and lactate were also calculated (Figure 3 and Table 4).

Table 2

Univariate logistic regression analysis of severe poisoning and in-hospital mortality

Variables Severe poisoning Death
OR 95% CI p-value OR 95% CI p-value
Age (years) 1.33 1.14–1.56 <0.001 1.18 0.92–1.51 0.182
Male 1.20 0.75–1.93 0.451 2.2 0.99–5.22 0.06
Hypertension, n (%) 2.48 1.11–5.37 0.023 0.94 0.15–3.39 0.935
Diabetes, n (%) 3.91 1.53–10.16 0.004 7.22 2.35–20.23 <0.001
Neutrophil 1.13 1.09–1.18 <0.001 1.09 1.03–1.15 0.002
Lymphocyte 0.22 0.12–0.38 <0.001 0.4 0.17–0.84 0.027
NLR 1.13 1.10–1.17 <0.001 1.07 1.01–1.11 <0.001
pChE 0.93 0.90–0.96 <0.001 0.91 0.82–0.97 0.014
Amylase 1.02 1.01–1.03 <0.001 1.02 1.01–1.03 0.002
sCr 1.18 1.09–1.29 <0.001 1.22 1.11–1.36 <0.001
Lactate 1.18 1.06–1.32 0.003 1.14 0.97–1.32 0.082

OR, odds ratio; CI, confidence interval; NLR, neutrophil-to-lymphocyte ratio; pChE, plasma cholinesterase; sCr, serum creatinine.

Table 3

Multivariate logistic regression analysis of severe poisoning and in-hospital mortality

Variables Severe poisoning Death
AOR 95% CI p-value AOR 95% CI p-value
Age (years) 1.18 0.96–1.45 0.112 NI
Diabetes, n (%) NI 15.88 3.12–86.46 <0.001
Hypertension, n (%) 2.28 0.77–6.58 0.129 0.15 0.01–0.99 0.076
NLR 1.13 1.10–1.17 <0.001 1.07 1.03–1.11 <0.001
pChE 0.94 0.90–0.98 0.002 0.93 0.84–0.99 0.078
Amylase 1.01 1.00–1.02 0.085 NI
sCr 1.13 1.05–1.25 0.006 1.22 1.10–1.37 <0.001
Lactate 1.17 1.00–1.36 0.042 NI

AOR, adjusted odds ratio; CI, confidence interval; NI, not included in the model; NLR, neutrophil-to-lymphocyte ratio; pChE, plasma cholinesterase; sCr, serum creatinine.

Figure 2 
                  Area under the receiver operating characteristic curve of the neutrophil-to-lymphocyte ratio (NLR) for predicting severe poisoning and in-hospital mortality. NLR with cutoff values.
Figure 2

Area under the receiver operating characteristic curve of the neutrophil-to-lymphocyte ratio (NLR) for predicting severe poisoning and in-hospital mortality. NLR with cutoff values.

Table 4

Area under the receiver operating characteristic curve for severe poisoning and in-hospital mortality

Variables Severe poisoning Death
AUC 95% CI AUC 95% CI
NLR 0.83 0.79–0.89 0.75 0.66–0.84
pChE 0.69 0.62–0.75 0.65 0.57–0.74
Amylase 0.63 0.56–0.70 0.70 0.59–0.81
sCr 0.63 0.56–0.63 0.75 0.64–0.86
Lactate 0.60 0.53–0.67 0.59 0.47–0.71

CI, confidence interval; NLR, neutrophil-to-lymphocyte ratio; pChE, plasma cholinesterase; sCr, serum creatinine.

Figure 3 
                  Area under the receiver operating characteristic curve for severe poisoning (a) and death (b).
Figure 3

Area under the receiver operating characteristic curve for severe poisoning (a) and death (b).

4 Discussion

Pesticide exposure remains a global public health problem [15]. OPs are responsible for the majority of deaths in self-poisoning cases, particularly in rural areas [16]. The estimated annual number of deaths from AOPP worldwide is 100,000 [17]. Despite the availability of specific treatments, mortality can reach more than 20% [18]. Therefore, evaluating the severity of AOPP is essential, and timely and accurate assessments by emergency physicians can help improve treatment efficacy.

This study investigated demographic and clinical parameters associated with the prognosis of AOPP. The rate of severe poisoning and in-hospital mortality was significantly higher in the high NLR group. Multivariate logistic regression analysis showed that NLR on admission was an independent predictor of poor prognosis in patients with AOPP after adjusting for covariates.

Severe AOPP causes failure of multiple organs, and clinical manifestations include respiratory failure, acute myocardial injury, cognitive impairment caused by nervous system injury, and decline in spatial learning ability [19,20,21]. Nonetheless, the molecular mechanisms underlying AOPP are not fully understood and may include the inhibition of cholinesterase activity in the nervous system, resulting in the accumulation of acetylcholine and the dysfunction of the cholinergic system [17] and inhibition of mitochondrial oxidative phosphorylation and mitochondrial membrane disruption [22]. The leakage of electrons in the mitochondrial respiratory chain produces reactive oxygen species (ROS), resulting in oxidative damage, which impairs mitochondrial function, cellular respiration, and energy production, ultimately leading to cell apoptosis and necrosis [23,24].

The clinical variables currently used to predict the severity of AOPP include APACHE II scores [2], plasma cholinesterase activity, plasma amylase [5,25], and blood lactate [3]. However, the clinical usefulness of these variables is limited. APACHE II scores evaluate disease severity based on patient age, medical history, and 12 physiological parameters measured at admission. This scoring system is complex and depends on a subjective assessment of clinical data; thus, it is difficult to apply in emergency settings because of its high complexity. Blood lactate is a marker of AOPP severity and prognosis [7]. In our cohort, blood lactate level was significantly higher in patients with higher NLR at 24 h post-poisoning than in patients with lower NLR. In the regression analysis, blood lactate was an independent predictor of severe poisoning but not of mortality, which agrees with a previous study [26].

Increased mortality in older patients with AOPP may be due to a decline in cholinergic function [27,28]. However, univariate and multivariate logistic regression analyses showed that age was not an independent predictor of poor prognosis in our cohort, and this result may be due to the small sample size.

Tallat et al. reported that serum caspase activity was a good predictor of outcome and mortality in patients with AOPP [4]; nonetheless, this marker is not used on a large scale because it is difficult to measure in the clinical setting. Farooqui et al. discussed the possibility of using latent class growth analysis to assess the relationship between vital signs and OP poisoning and proved that systolic blood pressure trajectories, heart and respiratory rate, and partial oxygen pressure were significantly associated with an increased risk of mortality in OP poisoning [8]. However, these authors did not identify a set of parameters that could be jointly used to guide clinical practice.

pChE activity is considered a good biomarker of exposure to OPs. However, there was no significant difference in the plasma concentrations of pChE between non-survivors and survivors (p = 0.078) in our cohort, and this result seems to corroborate a previous study [29]. pChE is not an accurate predictor of AOPP severity because it is not involved in cholinergic transmission in the nervous system [29] and, therefore, should be used in conjunction with other biomarkers.

The NLR reflects the interaction between host factors and the immune system in the disease state [30,31]. A retrospective study found that leukocyte and neutrophil counts and the NLR increased significantly in ventilated patients and non-survivors of acute pesticide poisoning, demonstrating that these parameters are useful for determining prognosis in patients with pesticide poisoning [32]. Our results suggest that the NLR can be used to predict severe poisoning and in-hospital mortality in patients with AOPP.

This study has strengths. First, poor prognosis included hypotension, ventilator support, cardiac arrest, and death. In contrast, previous studies are susceptible to bias because the only outcome evaluated was death. In our clinical practice, patients with severe AOPP associated with hemodynamic instability, coma, or respiratory failure are admitted to intensive care; therefore, the early assessment of the clinical status of patients is crucial to improve prognosis and reduce the total cost of hospitalization. Second, the NLR can be easily measured at the bedside by clinicians.

The study has limitations. First, the sample size was small. Second, retrospective studies are prone to bias by limiting comprehensive data collection. Third, the single-center nature of our study limits the applicability of the results to other healthcare settings or patient populations, and larger multicenter studies are warranted to confirm our findings.

5 Conclusion

High NLR is significantly associated with a poor prognosis of AOPP. Therefore, patients can be screened in time according to clinical symptoms and NLR values, so that medical staff can focus on the treatment and clinical progress of patients with poor prognosis. After stabilizing vital signs, AOPP patients with NLR >13 can be transferred to intensive care units and promptly receive ventilation support and appropriate treatment to improve prognosis and reduce total hospitalization cost.


Yuhang Mu and Boqi Hu contributed equally to this work.

tel: +86-043188782840

  1. Funding information: The authors state no funding involved.

  2. Conflict of interest: The authors state no conflict of interest.

  3. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Appendix

Table A1

Assessment of collinearity in the multivariate model using the variance inflation factor

Variables Variance inflation factor
Severe organophosphorus pesticide poisoning Death
Age (years) 1.16 NA
Diabetes, n (%) NA 1.60
Hypertension, n (%) 1.15 1.59
NLR 1.04 1.03
pChE 1.07 1.03
Amylase 1.07 NA
sCr 1.04 1.05
Lactic acid 1.09 NA

References

[1] Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang SS, Phillips MR, et al. The global burden of fatal self-poisoning with pesticides 2006–15: systematic review. J Affect Disord. 2017;219:93–104. 10.1016/j.jad.2017.05.002.Suche in Google Scholar PubMed

[2] Wu X, Xie W, Cheng Y, Guan Q. Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACHE II score. Exp Ther Med. 2016;11(3):806–10. 10.3892/etm.2016.2982.Suche in Google Scholar PubMed PubMed Central

[3] Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care. 2009;13(3):R90. 10.1186/cc7918.Suche in Google Scholar PubMed PubMed Central

[4] Tallat S, Hussien R, Mohamed RH, Abd El Wahab MB, Mahmoud M. Caspases as prognostic markers and mortality predictors in acute organophosphorus poisoning. J Genet Eng Biotechnol. 2020;18(1):10. 10.1186/s43141-020-00024-y.Suche in Google Scholar PubMed PubMed Central

[5] Dungdung A, Kumar A, Kumar B, Preetam M, Tara RK, Saba MK. Correlation and prognostic significance of serum amylase, serum lipase, and plasma cholinesterase in acute organophosphorus poisoning. J Family Med Prim Care. 2020;9(4):1873–7. 10.4103/jfmpc.jfmpc_205_20.Suche in Google Scholar PubMed PubMed Central

[6] Dong N, Liu J, Wang Z, Gao N, Pang L, Xing J. Development of a practical prediction scoring system for severe acute organophosphate poisoning. J Appl Toxicol. 2020;40(7):889–96. 10.1002/jat.3950.Suche in Google Scholar PubMed

[7] Yuan S, Gao Y, Ji W, Song J, Mei X. The evaluation of acute physiology and chronic health evaluation II score, poisoning severity score, sequential organ failure assessment score combine with lactate to assess the prognosis of the patients with acute organophosphate pesticide poisoning. Medicine (Baltimore). 2018;97(21):e10862. 10.1097/MD.0000000000010862.Suche in Google Scholar PubMed PubMed Central

[8] Farooqui WA, Uddin M, Qadeer R, Shafique K. Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients – a latent class growth analysis. BMC Public Health. 2020;20(1):1538. 10.1186/s12889-020-09637-x.Suche in Google Scholar PubMed PubMed Central

[9] Akilli NB, Yortanli M, Mutlu H, Gunaydin YK, Koylu R, Akca HS, et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med. 2014;32(12):1476–80. 10.1016/j.ajem.2014.09.001.Suche in Google Scholar PubMed

[10] Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther. 2016;14(5):573–7. 10.1586/14779072.2016.1154788.Suche in Google Scholar PubMed

[11] Luo Y, Xia LX, Li ZL, Pi DF, Tan XP, Tu Q. Early neutrophil-to-lymphocyte ratio is a prognostic marker in acute minor stroke or transient ischemic attack. Acta Neurol Belg. 2020. 10.1007/s13760-020-01289-3.Suche in Google Scholar

[12] Ying HQ, Deng QW, He BS, Pan YQ, Wang F, Sun HL, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014;31(12):305. 10.1007/s12032-014-0305-0.Suche in Google Scholar

[13] Omichi K, Cloyd JM, Yamashita S, Tzeng CD, Conrad C, Chun YS, et al. Neutrophil-to-lymphocyte ratio predicts prognosis after neoadjuvant chemotherapy and resection of intrahepatic cholangiocarcinoma. Surgery. 2017;162(4):752–65. 10.1016/j.surg.2017.05.015.Suche in Google Scholar

[14] Mandaliya H, Jones M, Oldmeadow C, Nordman II. Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI). Transl Lung Cancer Res. 2019;8(6):886–94. 10.21037/tlcr.2019.11.16.Suche in Google Scholar

[15] Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9612):597–607. 10.1016/S0140-6736(07)61202-1.Suche in Google Scholar

[16] Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM. 2000;93(11):715–31. 10.1093/qjmed/93.11.715.Suche in Google Scholar PubMed

[17] Eddleston M. Novel clinical toxicology and pharmacology of organophosphorus insecticide self-poisoning. Annu Rev Pharmacol Toxicol. 2019;59:341–60. 10.1146/annurev-pharmtox-010818-021842.Suche in Google Scholar PubMed

[18] Vale A. Organophosphorus insecticide poisoning. BMJ Clin Evid. 2015;2015:2102.10.1016/B978-0-444-62627-1.00010-XSuche in Google Scholar

[19] Nomura K, Narimatsu E, Inoue H, Kyan R, Sawamoto K, Uemura S, et al. Mechanism of central hypopnoea induced by organic phosphorus poisoning. Sci Rep. 2020;10(1):15834. 10.1038/s41598-020-73003-5.Suche in Google Scholar PubMed PubMed Central

[20] Naughton SX, Terry AV Jr. Neurotoxicity in acute and repeated organophosphate exposure. Toxicology. 2018;408:101–12. 10.1016/j.tox.2018.08.011.Suche in Google Scholar PubMed PubMed Central

[21] Chen KX, Zhou XH, Sun CA, Yan PX. Manifestations of and risk factors for acute myocardial injury after acute organophosphorus pesticide poisoning. Medicine (Baltimore). 2019;98(6):e14371. 10.1097/MD.0000000000014371.Suche in Google Scholar PubMed PubMed Central

[22] Karami-Mohajeri S, Abdollahi M. Mitochondrial dysfunction and organophosphorus compounds. Toxicol Appl Pharmacol. 2013;270(1):39–44. 10.1016/j.taap.2013.04.001.Suche in Google Scholar PubMed

[23] Binukumar BK, Bal A, Kandimalla R, Sunkaria A, Gill KD. Mitochondrial energy metabolism impairment and liver dysfunction following chronic exposure to dichlorvos. Toxicology. 2010;270(2–3):77–84. 10.1016/j.tox.2010.01.017.Suche in Google Scholar PubMed

[24] Hou YX, Liu SW, Wang LW, Wu SH. Physiopathology of multiple organ dysfunctions in severely monocrotophos-poisoned rabbits. Chem Biol Interact. 2017;278:9–14. 10.1016/j.cbi.2017.08.016.Suche in Google Scholar PubMed

[25] Sumathi ME, Kumar SH, Shashidhar KN, Takkalaki N. Prognostic significance of various biochemical parameters in acute organophosphorus poisoning. Toxicol Int. 2014;21(2):167–71. 10.4103/0971-6580.139800.Suche in Google Scholar PubMed PubMed Central

[26] Erfantalab P, Soltaninejad K, Shadnia S, Zamani N, Hassanian-Moghaddam H, Mahdavinejad A, et al. Trend of blood lactate level in acute aluminum phosphide poisoning. World J Emerg Med. 2017;8(2):116–20. 10.5847/wjem.j.1920-8642.2017.02.006.Suche in Google Scholar PubMed PubMed Central

[27] Gamage R, Wagnon I, Rossetti I, Childs R, Niedermayer G, Chesworth R, et al. Cholinergic modulation of glial function during aging and chronic neuroinflammation. Front Cell Neurosci. 2020;14:577–912. 10.3389/fncel.2020.577912.Suche in Google Scholar PubMed PubMed Central

[28] Gunduz E, Dursun R, Icer M, Zengin Y, Gullu MN, Durgun HM, et al. Factors affecting mortality in patients with organophosphate poisoning. J Pak Med Assoc. 2015;65(9):967–72.Suche in Google Scholar

[29] Jokanovic M. Neurotoxic effects of organophosphorus pesticides and possible association with neurodegenerative diseases in man: a review. Toxicology. 2018;410:125–31. 10.1016/j.tox.2018.09.009.Suche in Google Scholar PubMed

[30] Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther. 2010;87(4):504–8. 10.1038/clpt.2009.254.Suche in Google Scholar PubMed

[31] Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63. 10.2217/fon.09.136.Suche in Google Scholar PubMed

[32] Dundar ZD, Ergin M, Koylu R, Ozer R, Cander B, Gunaydin YK. Neutrophil-lymphocyte ratio in patients with pesticide poisoning. J Emerg Med. 2014;47(3):286–93. 10.1016/j.jemermed.2014.01.034.Suche in Google Scholar PubMed

Received: 2021-02-04
Revised: 2021-06-03
Accepted: 2021-06-03
Published Online: 2021-07-15

© 2021 Yuhang Mu et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

  1. Biomedical Sciences
  2. Research progress on the mechanism of orexin in pain regulation in different brain regions
  3. Adriamycin-resistant cells are significantly less fit than adriamycin-sensitive cells in cervical cancer
  4. Exogenous spermidine affects polyamine metabolism in the mouse hypothalamus
  5. Iris metastasis of diffuse large B-cell lymphoma misdiagnosed as primary angle-closure glaucoma: A case report and review of the literature
  6. LncRNA PVT1 promotes cervical cancer progression by sponging miR-503 to upregulate ARL2 expression
  7. Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: The hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio
  8. Circ_0091579 enhances the malignancy of hepatocellular carcinoma via miR-1287/PDK2 axis
  9. Silencing XIST mitigated lipopolysaccharide (LPS)-induced inflammatory injury in human lung fibroblast WI-38 cells through modulating miR-30b-5p/CCL16 axis and TLR4/NF-κB signaling pathway
  10. Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats
  11. ABCB1 polymorphism in clopidogrel-treated Montenegrin patients
  12. Metabolic profiling of fatty acids in Tripterygium wilfordii multiglucoside- and triptolide-induced liver-injured rats
  13. miR-338-3p inhibits cell growth, invasion, and EMT process in neuroblastoma through targeting MMP-2
  14. Verification of neuroprotective effects of alpha-lipoic acid on chronic neuropathic pain in a chronic constriction injury rat model
  15. Circ_WWC3 overexpression decelerates the progression of osteosarcoma by regulating miR-421/PDE7B axis
  16. Knockdown of TUG1 rescues cardiomyocyte hypertrophy through targeting the miR-497/MEF2C axis
  17. MiR-146b-3p protects against AR42J cell injury in cerulein-induced acute pancreatitis model through targeting Anxa2
  18. miR-299-3p suppresses cell progression and induces apoptosis by downregulating PAX3 in gastric cancer
  19. Diabetes and COVID-19
  20. Discovery of novel potential KIT inhibitors for the treatment of gastrointestinal stromal tumor
  21. TEAD4 is a novel independent predictor of prognosis in LGG patients with IDH mutation
  22. circTLK1 facilitates the proliferation and metastasis of renal cell carcinoma by regulating miR-495-3p/CBL axis
  23. microRNA-9-5p protects liver sinusoidal endothelial cell against oxygen glucose deprivation/reperfusion injury
  24. Long noncoding RNA TUG1 regulates degradation of chondrocyte extracellular matrix via miR-320c/MMP-13 axis in osteoarthritis
  25. Duodenal adenocarcinoma with skin metastasis as initial manifestation: A case report
  26. Effects of Loofah cylindrica extract on learning and memory ability, brain tissue morphology, and immune function of aging mice
  27. Recombinant Bacteroides fragilis enterotoxin-1 (rBFT-1) promotes proliferation of colorectal cancer via CCL3-related molecular pathways
  28. Blocking circ_UBR4 suppressed proliferation, migration, and cell cycle progression of human vascular smooth muscle cells in atherosclerosis
  29. Gene therapy in PIDs, hemoglobin, ocular, neurodegenerative, and hemophilia B disorders
  30. Downregulation of circ_0037655 impedes glioma formation and metastasis via the regulation of miR-1229-3p/ITGB8 axis
  31. Vitamin D deficiency and cardiovascular risk in type 2 diabetes population
  32. Circ_0013359 facilitates the tumorigenicity of melanoma by regulating miR-136-5p/RAB9A axis
  33. Mechanisms of circular RNA circ_0066147 on pancreatic cancer progression
  34. lncRNA myocardial infarction-associated transcript (MIAT) knockdown alleviates LPS-induced chondrocytes inflammatory injury via regulating miR-488-3p/sex determining region Y-related HMG-box 11 (SOX11) axis
  35. Identification of circRNA circ-CSPP1 as a potent driver of colorectal cancer by directly targeting the miR-431/LASP1 axis
  36. Hyperhomocysteinemia exacerbates ischemia-reperfusion injury-induced acute kidney injury by mediating oxidative stress, DNA damage, JNK pathway, and apoptosis
  37. Potential prognostic markers and significant lncRNA–mRNA co-expression pairs in laryngeal squamous cell carcinoma
  38. Gamma irradiation-mediated inactivation of enveloped viruses with conservation of genome integrity: Potential application for SARS-CoV-2 inactivated vaccine development
  39. ADHFE1 is a correlative factor of patient survival in cancer
  40. The association of transcription factor Prox1 with the proliferation, migration, and invasion of lung cancer
  41. Is there a relationship between the prevalence of autoimmune thyroid disease and diabetic kidney disease?
  42. Immunoregulatory function of Dictyophora echinovolvata spore polysaccharides in immunocompromised mice induced by cyclophosphamide
  43. T cell epitopes of SARS-CoV-2 spike protein and conserved surface protein of Plasmodium malariae share sequence homology
  44. Anti-obesity effect and mechanism of mesenchymal stem cells influence on obese mice
  45. Long noncoding RNA HULC contributes to paclitaxel resistance in ovarian cancer via miR-137/ITGB8 axis
  46. Glucocorticoids protect HEI-OC1 cells from tunicamycin-induced cell damage via inhibiting endoplasmic reticulum stress
  47. Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning
  48. Gastroprotective effects of diosgenin against HCl/ethanol-induced gastric mucosal injury through suppression of NF-κβ and myeloperoxidase activities
  49. Silencing of LINC00707 suppresses cell proliferation, migration, and invasion of osteosarcoma cells by modulating miR-338-3p/AHSA1 axis
  50. Successful extracorporeal membrane oxygenation resuscitation of patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism: A case report
  51. Effects of miR-185-5p on replication of hepatitis C virus
  52. Lidocaine has antitumor effect on hepatocellular carcinoma via the circ_DYNC1H1/miR-520a-3p/USP14 axis
  53. Primary localized cutaneous nodular amyloidosis presenting as lymphatic malformation: A case report
  54. Multimodal magnetic resonance imaging analysis in the characteristics of Wilson’s disease: A case report and literature review
  55. Therapeutic potential of anticoagulant therapy in association with cytokine storm inhibition in severe cases of COVID-19: A case report
  56. Neoadjuvant immunotherapy combined with chemotherapy for locally advanced squamous cell lung carcinoma: A case report and literature review
  57. Rufinamide (RUF) suppresses inflammation and maintains the integrity of the blood–brain barrier during kainic acid-induced brain damage
  58. Inhibition of ADAM10 ameliorates doxorubicin-induced cardiac remodeling by suppressing N-cadherin cleavage
  59. Invasive ductal carcinoma and small lymphocytic lymphoma/chronic lymphocytic leukemia manifesting as a collision breast tumor: A case report and literature review
  60. Clonal diversity of the B cell receptor repertoire in patients with coronary in-stent restenosis and type 2 diabetes
  61. CTLA-4 promotes lymphoma progression through tumor stem cell enrichment and immunosuppression
  62. WDR74 promotes proliferation and metastasis in colorectal cancer cells through regulating the Wnt/β-catenin signaling pathway
  63. Down-regulation of IGHG1 enhances Protoporphyrin IX accumulation and inhibits hemin biosynthesis in colorectal cancer by suppressing the MEK-FECH axis
  64. Curcumin suppresses the progression of gastric cancer by regulating circ_0056618/miR-194-5p axis
  65. Scutellarin-induced A549 cell apoptosis depends on activation of the transforming growth factor-β1/smad2/ROS/caspase-3 pathway
  66. lncRNA NEAT1 regulates CYP1A2 and influences steroid-induced necrosis
  67. A two-microRNA signature predicts the progression of male thyroid cancer
  68. Isolation of microglia from retinas of chronic ocular hypertensive rats
  69. Changes of immune cells in patients with hepatocellular carcinoma treated by radiofrequency ablation and hepatectomy, a pilot study
  70. Calcineurin Aβ gene knockdown inhibits transient outward potassium current ion channel remodeling in hypertrophic ventricular myocyte
  71. Aberrant expression of PI3K/AKT signaling is involved in apoptosis resistance of hepatocellular carcinoma
  72. Clinical significance of activated Wnt/β-catenin signaling in apoptosis inhibition of oral cancer
  73. circ_CHFR regulates ox-LDL-mediated cell proliferation, apoptosis, and EndoMT by miR-15a-5p/EGFR axis in human brain microvessel endothelial cells
  74. Resveratrol pretreatment mitigates LPS-induced acute lung injury by regulating conventional dendritic cells’ maturation and function
  75. Ubiquitin-conjugating enzyme E2T promotes tumor stem cell characteristics and migration of cervical cancer cells by regulating the GRP78/FAK pathway
  76. Carriage of HLA-DRB1*11 and 1*12 alleles and risk factors in patients with breast cancer in Burkina Faso
  77. Protective effect of Lactobacillus-containing probiotics on intestinal mucosa of rats experiencing traumatic hemorrhagic shock
  78. Glucocorticoids induce osteonecrosis of the femoral head through the Hippo signaling pathway
  79. Endothelial cell-derived SSAO can increase MLC20 phosphorylation in VSMCs
  80. Downregulation of STOX1 is a novel prognostic biomarker for glioma patients
  81. miR-378a-3p regulates glioma cell chemosensitivity to cisplatin through IGF1R
  82. The molecular mechanisms underlying arecoline-induced cardiac fibrosis in rats
  83. TGF-β1-overexpressing mesenchymal stem cells reciprocally regulate Th17/Treg cells by regulating the expression of IFN-γ
  84. The influence of MTHFR genetic polymorphisms on methotrexate therapy in pediatric acute lymphoblastic leukemia
  85. Red blood cell distribution width-standard deviation but not red blood cell distribution width-coefficient of variation as a potential index for the diagnosis of iron-deficiency anemia in mid-pregnancy women
  86. Small cell neuroendocrine carcinoma expressing alpha fetoprotein in the endometrium
  87. Superoxide dismutase and the sigma1 receptor as key elements of the antioxidant system in human gastrointestinal tract cancers
  88. Molecular characterization and phylogenetic studies of Echinococcus granulosus and Taenia multiceps coenurus cysts in slaughtered sheep in Saudi Arabia
  89. ITGB5 mutation discovered in a Chinese family with blepharophimosis-ptosis-epicanthus inversus syndrome
  90. ACTB and GAPDH appear at multiple SDS-PAGE positions, thus not suitable as reference genes for determining protein loading in techniques like Western blotting
  91. Facilitation of mouse skin-derived precursor growth and yield by optimizing plating density
  92. 3,4-Dihydroxyphenylethanol ameliorates lipopolysaccharide-induced septic cardiac injury in a murine model
  93. Downregulation of PITX2 inhibits the proliferation and migration of liver cancer cells and induces cell apoptosis
  94. Expression of CDK9 in endometrial cancer tissues and its effect on the proliferation of HEC-1B
  95. Novel predictor of the occurrence of DKA in T1DM patients without infection: A combination of neutrophil/lymphocyte ratio and white blood cells
  96. Investigation of molecular regulation mechanism under the pathophysiology of subarachnoid hemorrhage
  97. miR-25-3p protects renal tubular epithelial cells from apoptosis induced by renal IRI by targeting DKK3
  98. Bioengineering and Biotechnology
  99. Green fabrication of Co and Co3O4 nanoparticles and their biomedical applications: A review
  100. Agriculture
  101. Effects of inorganic and organic selenium sources on the growth performance of broilers in China: A meta-analysis
  102. Crop-livestock integration practices, knowledge, and attitudes among smallholder farmers: Hedging against climate change-induced shocks in semi-arid Zimbabwe
  103. Food Science and Nutrition
  104. Effect of food processing on the antioxidant activity of flavones from Polygonatum odoratum (Mill.) Druce
  105. Vitamin D and iodine status was associated with the risk and complication of type 2 diabetes mellitus in China
  106. Diversity of microbiota in Slovak summer ewes’ cheese “Bryndza”
  107. Comparison between voltammetric detection methods for abalone-flavoring liquid
  108. Composition of low-molecular-weight glutenin subunits in common wheat (Triticum aestivum L.) and their effects on the rheological properties of dough
  109. Application of culture, PCR, and PacBio sequencing for determination of microbial composition of milk from subclinical mastitis dairy cows of smallholder farms
  110. Investigating microplastics and potentially toxic elements contamination in canned Tuna, Salmon, and Sardine fishes from Taif markets, KSA
  111. From bench to bar side: Evaluating the red wine storage lesion
  112. Establishment of an iodine model for prevention of iodine-excess-induced thyroid dysfunction in pregnant women
  113. Plant Sciences
  114. Characterization of GMPP from Dendrobium huoshanense yielding GDP-D-mannose
  115. Comparative analysis of the SPL gene family in five Rosaceae species: Fragaria vesca, Malus domestica, Prunus persica, Rubus occidentalis, and Pyrus pyrifolia
  116. Identification of leaf rust resistance genes Lr34 and Lr46 in common wheat (Triticum aestivum L. ssp. aestivum) lines of different origin using multiplex PCR
  117. Investigation of bioactivities of Taxus chinensis, Taxus cuspidata, and Taxus × media by gas chromatography-mass spectrometry
  118. Morphological structures and histochemistry of roots and shoots in Myricaria laxiflora (Tamaricaceae)
  119. Transcriptome analysis of resistance mechanism to potato wart disease
  120. In silico analysis of glycosyltransferase 2 family genes in duckweed (Spirodela polyrhiza) and its role in salt stress tolerance
  121. Comparative study on growth traits and ions regulation of zoysiagrasses under varied salinity treatments
  122. Role of MS1 homolog Ntms1 gene of tobacco infertility
  123. Biological characteristics and fungicide sensitivity of Pyricularia variabilis
  124. In silico/computational analysis of mevalonate pyrophosphate decarboxylase gene families in Campanulids
  125. Identification of novel drought-responsive miRNA regulatory network of drought stress response in common vetch (Vicia sativa)
  126. How photoautotrophy, photomixotrophy, and ventilation affect the stomata and fluorescence emission of pistachios rootstock?
  127. Apoplastic histochemical features of plant root walls that may facilitate ion uptake and retention
  128. Ecology and Environmental Sciences
  129. The impact of sewage sludge on the fungal communities in the rhizosphere and roots of barley and on barley yield
  130. Domestication of wild animals may provide a springboard for rapid variation of coronavirus
  131. Response of benthic invertebrate assemblages to seasonal and habitat condition in the Wewe River, Ashanti region (Ghana)
  132. Molecular record for the first authentication of Isaria cicadae from Vietnam
  133. Twig biomass allocation of Betula platyphylla in different habitats in Wudalianchi Volcano, northeast China
  134. Animal Sciences
  135. Supplementation of probiotics in water beneficial growth performance, carcass traits, immune function, and antioxidant capacity in broiler chickens
  136. Predators of the giant pine scale, Marchalina hellenica (Gennadius 1883; Hemiptera: Marchalinidae), out of its natural range in Turkey
  137. Honey in wound healing: An updated review
  138. NONMMUT140591.1 may serve as a ceRNA to regulate Gata5 in UT-B knockout-induced cardiac conduction block
  139. Radiotherapy for the treatment of pulmonary hydatidosis in sheep
  140. Retraction
  141. Retraction of “Long non-coding RNA TUG1 knockdown hinders the tumorigenesis of multiple myeloma by regulating microRNA-34a-5p/NOTCH1 signaling pathway”
  142. Special Issue on Reuse of Agro-Industrial By-Products
  143. An effect of positional isomerism of benzoic acid derivatives on antibacterial activity against Escherichia coli
  144. Special Issue on Computing and Artificial Techniques for Life Science Applications - Part II
  145. Relationship of Gensini score with retinal vessel diameter and arteriovenous ratio in senile CHD
  146. Effects of different enantiomers of amlodipine on lipid profiles and vasomotor factors in atherosclerotic rabbits
  147. Establishment of the New Zealand white rabbit animal model of fatty keratopathy associated with corneal neovascularization
  148. lncRNA MALAT1/miR-143 axis is a potential biomarker for in-stent restenosis and is involved in the multiplication of vascular smooth muscle cells
Heruntergeladen am 8.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/biol-2021-0069/html
Button zum nach oben scrollen