Prognostic value of serial serum cholinesterase activities
in organophosphate poisoned patients
Hsien-Yi Chen MD, Warren Wei-Jen Wang MD,
Chung-Hsien Chaou MD, Chih-Chuan Lin MD
Department of Emergency Medicine, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Received 15 February 2008; revised 1 July 2008; accepted 2 July 2008
Objectives: Organophosphate (OP) poisoning is a worldwide concern. Several factors have been
identified to predict outcomes of OP poisoned patients. This study focuses on the relationship between the
trend in Serum cholinesterase (SChE) activity and its clinical outcome in acute OP poisoned patients.
Methods: We retrospectively reviewed the medical records of all adult acute OP poisoned patients that
visited the Emergency Department from 2000 to 2006. These patients were divided into two groups: the
deceased patients as the sample group and all others as the control group. We collected data on the
following: demographical factors, poisoning history, clinical manifestation, Glasgow Coma Scale (GCS),
APACHE II score, all SChE data within 48 hours, hourly 2-PAM dosage, intubation, and mortality. Chi-
Square test then examined the relationship between the trend of SChE activity and mortality.
Results: 86 patients were enrolled. Follow-up measurements of SChE activity within 48 hours of
poisoning were available in 50 cases. Among these, eight patients died. We found no significant difference
between the sample and control groups on initial SChE activity, time interval to initial SChE data, and
hourly 2-PAM dosage. The sampled group possessed a worse GCS score, lower systolic blood pressure,
and a higher APACH II score. Increase patient mortality rates associated with the absence of elevating
SChE activity within 48 hours of poisoning. (P = .006, odds ratio:11).
Conclusions: We propose that the absence of elevating SChE activity level within 48 hours of poisoning
appears to associate with higher mortality in acute OP poisoned patients.
© 2009 Elsevier Inc. All rights reserved.
Organophosphate (OP) poisoning is a major problem
worldwide. The World Health Organization (WHO) has
estimated that more than 300 million acute pesticide
poisoning occur worldwide each year. Most of these cases
were results of OP intoxication . Current literature
indicates an 11% to 23% worldwide OP poisoning–related
mortality rates [2-4]. Taiwan's agricultural sector, with its
heavy pesticide dependence is no exception, with a fatality
rates as high as 23% . Factors such as the Glasgow Coma
Scale (GCS), Acute Physiology And Chronic Health
Evaluation Score II (APACHE II score), blood pressure,
electrocardiogram findings, serum amylase level, and Pa
in arterial blood gas have been identified to predict the
outcome in acute OP-poisoned patients.[3,5-10].
Corresponding author. Department of Emergency Medicine, Chang-
Gung Memorial Hospital, Taoyuan, Taiwan. Tel.: +886 3 3281200 3347;
fax: + 886 3 3287715.
E-mail address: email@example.com (C.-C. Lin).
0735-6757/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
American Journal of Emergency Medicine (2009) 27, 1034–1039