A study of correlation of serum cholinesterase level, clinical score by peradeniya poisoning scale at presentation and severity of organopoisoning

Abstract

OBJECTIVE: To evaluate the correlation between serum cholinesterase levels, clinical severity assessed by the Peradeniya Organophosphorus Poisoning (POP) scale, and outcomes in patients with organophosphorus poisoning. BACKGROUND: Organophosphorus (OP) compounds, widely used as pesticides in agricultural communities, are a major cause of poisoning in developing countries. Their toxicity arises from acetylcholinesterase inhibition, leading to acetylcholine accumulation at synapses and subsequent cholinergic crisis. While clinical scoring systems and laboratory markers aid severity assessment, their interrelation and prognostic utility remain understudied. METHODS: This prospective study included 100 patients with organophosphorus poisoning. Demographic data, clinical features, serum cholinesterase levels, and POP scale scores are recorded at presentation. Patients are followed up during their hospital stay to document management parameters (intubation requirement, atropine dose, and duration of hospitalization) and final outcomes. RESULTS:  Demographics: Most patients were young adults (21–40 years; 66%), with a slight male predominance (53%).  Severity Distribution (POP scale): Mild (67%), moderate (31%), and severe (2%).  Serum Cholinesterase Levels: Significantly correlated with severity: mild (3211.4 ± 2631.8 U/L), moderate (2028.3 ± 2102.3 U/L), and severe (726.6 ± 886.2 U/L) (p = 0.05).  Management & Outcomes: o Intubation required: 20% of patients. o Mean atropine dose: 109.8 ± 48.7 mg, escalating with severity (p < 0.001). o Mortality: 13% overall, increasing from mild (2.9%) to moderate (29.03%) and severe (100%).  Prognostic Indicators: Both POP scale severity (p < 0.001) and cholinesterase levels (p = 0.004) strongly predicted outcomes. CONCLUSION: Serum cholinesterase levels and POP scale scores exhibit significant correlation with clinical severity and outcomes in OP poisoning. Combined use of clinical and laboratory parameters enhances risk stratification, guiding tailored management to improve survival.