Management of Paraquat poisoning: an umbrella review

Abstract

Paraquat poisoning is an emergency condition. There is no exact and accepted strategy for treating patients with paraquat poisoning. Since several systematic reviews and meta-analysis were published on the management of paraquat poisoning, this umbrella review of systematic reviews presents an overall picture of the evidence regarding the different management of paraquat poisoning to reach a general conclusion on what is the best treatment to reduce mortality. Methods: A comprehensive electronic search on relevant databases was conducted from inception to April 2022. Two authors independently screened the titles and abstracts and selected the full texts. In case of disagreement, a third author arbitrated. Only systematic reviews with or without meta‐analysis were eligible for this review. We used the JBI critical appraisal tools for systematic reviews to assess the methodological quality of systematic reviews.We reanalyzed each meta‐analysis using the using Comprehensive Meta-Analysis software (ver. 2.2; Biostat, Englewood, NJ, USA). Results: The primary search resulted in 123 titles, and after removing the duplicates, we reviewed 89 titles and abstracts. Finally, 34 full texts were selected, and of these, 11 qualitative systematic reviews or quantitative meta-analyses (including 12 trials) were eligible. The risk of bias assessment using JBI questionnaire showed that all of the studies had more than five ‘yes’ answers. Different therapeutic management were conducted on paraquat poisoning. The summary estimate shows that the mortality rate of patients with paraquat poisoning following all included interventions was 24% less likely to occur than routine management (RR: 0.763, 95% CI 0.649–0.897; P = 0.001). In subgroup analysis, the results showed that the efficacy of immunosuppressive therapy and Ambroxol was higher than the other interventions. The mortality rate following Ambroxol was 31% less likely to occur than routine management (RR: 0.690, 95% CI 0.552–0.863; P = 0.001). This reduced rate was similar to the immunosuppressive therapy (RR: 0.700, 95% CI: 0.627-0.782; P < 0.001). Other interventions had no effect in reduction of mortality rate (P> 0.05).