Role of Leukocyte Count, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio as a Prognostic Marker in Pesticide Poisoning.

Abstract

Introduction- Pesticides are chemical compounds used for crop protection from rodents and insects. As useful as they can be, poisoning with them is a very common occurrence in farmers. Therefore these are known as HHP (Highly hazardous pesticides) by WHO. In an emergency setting, the identification of quick and powerful prognostic markers can be of high significance in the management of these pesticide poisoning patients. Aims and Objectives- To assess the severity of Pesticide Poisoning by assessing the leukocyte count, neutrophil count, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio and its comparison with levels of Plasma Cholinesterase as an aid to clinical diagnosis, for early treatment of the patients. Materials and methods- A cross sectional study was done on 148 confirmed cases of pesticide poisoning admitted to the casualty in the period of 1.5 years (1st November 2018 - 30th May 2020). Blood samples were collected in EDTA and plain tubes within 24 hours of admission and the values of total leukocyte Count (TLC), neutrophil count, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and plasma cholinesterase (PChE) were measured and compared. The severity of poisoning was assessed according to Peradeniya Organophosphorus (POP) scale. Results- Majority of the patients were between 21-30 years. 67 (45.3%) were males and 81 (54.7%) were females. Approximately 89.86% (133 cases) of the poisoning cases were due to Organophosphorus compounds and remaining 10.14% (15 cases) were due to carbamate poisoning. The severely poisoned patients according to POP scale had more leukocyte count, neutrophil count, neutrophil-lymphocyte ratio and platelet lymphocyte ratio; and less plasma cholinesterase level as compared to the patients with mild and moderate poisoning. Conclusion- Total Leukocyte count, neutrophil count, neutrophil-lymphocyte ratio and platelet lymphocyte ratio are simple and easy to use parameters for estimating the severity of pesticide poisoning and assessing its prognosis.