European Journal of Cardiovascular Medicine

Organophosphorus (OP) compounds are widely used in agriculture and industry as pesticides and insecticides. Despite their utility, they pose a significant risk to human health due to their high toxicity. Acute poisoning with these substances remains a critical public health issue, particularly in developing countries where regulations may be less stringent and agricultural practices rely heavily on their use [1]. The primary mechanism of toxicity involves the inhibition of acetylcholinesterase, leading to an accumulation of acetylcholine in the nervous system, which can result in muscarinic and nicotinic symptoms and ultimately central nervous system dysfunction [2].

The clinical presentation of OP poisoning can vary widely, from mild symptoms such as headache and dizziness to severe cases involving respiratory failure and death. Early diagnosis and treatment are crucial for improving outcomes. Traditionally, the severity of poisoning has been assessed through clinical observation and measurement of cholinesterase activity, but these methods have limitations in predicting long-term outcomes and overall severity [3].

Recent studies have explored alternative biomarkers that could provide a more reliable indication of clinical severity and prognosis. Among these, serum creatine phosphokinase (CPK) has been identified as a potential prognostic marker. CPK is an enzyme found in the heart, brain, and skeletal muscle, and its levels can increase significantly in response to muscle damage, which is a common complication of severe OP poisoning [4]. Elevated CPK levels have been associated with poorer outcomes, suggesting that this enzyme could serve as a useful tool for assessing the extent of exposure and guiding therapeutic strategies [5].

Moreover, research into the epidemiology and treatment of OP poisoning has emphasized the need for improved diagnostic markers that can be used promptly at the point of care. The ability to rapidly assess the severity of poisoning could enable more targeted and effective interventions, potentially reducing the morbidity and mortality associated with these incidents [6]. This is particularly important in rural settings where healthcare resources are limited, and delays in treatment can be fatal. This study aims to evaluate the correlation between serum CPK levels and clinical severity in patients with OP poisoning to establish CPK as a reliable prognostic tool.

Study Design

This was a retrospective study.

Study Setting

The study will be conducted at the VSS Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha. This setting provides access to a large number of patient records, facilitating a comprehensive analysis of historical data.

Participants

A total of 160 participants will be selected from the patient records at VIMSAR. These records pertain to individuals who have been treated for organophosphorus poisoning within the study duration.

Inclusion Criteria:

• Patients with a confirmed diagnosis of organophosphorus poisoning.
• Age 18 years and older.
• Patients who have serum CPK levels recorded during their treatment.

Exclusion Criteria:

1. Patients with pre-existing muscular diseases, which could affect CPK levels.
2. Records with incomplete data regarding treatment or outcomes.
3. Patients who received treatment outside of the study duration.

Bias

To minimize selection bias, participants will be randomly selected from all eligible patient records. Information bias will be reduced by utilizing standardized forms for data extraction and employing cross-checks by different team members.

Data Collection

Data will be collected from electronic health records at VIMSAR. Information on demographic characteristics, clinical data, serum CPK levels, treatment details, and outcomes will be extracted using a standardized data collection form to ensure consistency.

Procedure

The procedure involves identifying eligible patient records, extracting relevant data, and assessing the correlation between serum CPK levels and clinical outcomes. The historical nature of the study allows for a comprehensive data review without direct patient interaction.

Statistical Analysis

Data analysis will be conducted using SPSS version 23.0. Descriptive statistics will be used to summarize demographic and clinical characteristics. The association between serum CPK levels and clinical severity will be analyzed using logistic regression models. Statistical significance will be set at a p-value of <0.05.

The demographic breakdown showcased a predominant male representation at 63.75% (102 males) and a lesser female representation at 36.25% (58 females). The age distribution was skewed towards the middle-aged group, with the largest segment falling between 31 and 50 years old, accounting for 43.75% of the sample. This demographic information is critical as it suggests the higher vulnerability of the working-age population to organophosphorus exposure, possibly due to occupational hazards.

Table 1: Demographic and Baseline Characteristics

We observed a significant variation in serum CPK levels among patients, reflecting a wide range of exposure and response severity. Patients who exhibited severe clinical outcomes had markedly higher median CPK levels, suggesting a dose-response relationship where higher toxin absorption correlates with more extensive muscle damage, as indicated by CPK release.

Table 2: Detailed CPK Levels and Clinical Severity

The logistic regression analysis provided a strong statistical backing for the role of CPK as a predictor of severity. Adjusting for confounders such as age, gender, and time to hospital admission, the analysis underscored that higher CPK levels significantly increase the likelihood of severe outcomes.

Table 3: Logistic Regression Analysis of CPK Levels and Clinical Severity

Further investigation into the time between exposure and hospital admission revealed that quicker medical intervention correlated with milder clinical outcomes. This analysis highlights the importance of timely healthcare access in mitigating the severity of poisoning.

Table 4: Time to Hospital Admission and Clinical Outcomes

The results involving 160 patients treated for organophosphorus poisoning indicate a significant correlation between serum creatine phosphokinase (CPK) levels and clinical severity. The demographic data revealed a majority of patients were male (63.75%) and predominantly between the ages of 31 and 50 years. This age group likely represents a higher risk population due to occupational exposure to organophosphorus compounds.

CPK levels varied widely among the patients, with severe clinical outcomes associated with markedly higher median CPK levels (650 U/L) compared to those with mild to moderate outcomes (150 U/L). This suggests that CPK levels could be a useful biomarker for assessing the extent of muscle damage and systemic response to poisoning, reflecting the severity of exposure.

The statistical analysis, particularly the logistic regression, reinforced these findings by demonstrating that an increase of 100 U/L in CPK levels was associated with a 2.5-fold increase in the odds of a severe clinical outcome. This relationship held even after adjusting for potential confounders such as age, gender, and time to hospital admission, indicating a robust association between CPK levels and the severity of poisoning.

Furthermore, the analysis of time to hospital admission highlighted the importance of rapid medical intervention. Patients admitted within six hours of exposure were more likely to experience mild to moderate outcomes, reinforcing the critical nature of timely treatment in mitigating the severity of organophosphorus poisoning.

Overall, the study suggests that serum CPK is a valuable prognostic marker in organophosphorus poisoning, with higher levels indicating greater clinical severity. This finding could be instrumental in guiding treatment decisions and prioritizing care for patients with high CPK readings upon admission. Moreover, the data emphasize the need for increased awareness and preventive measures, particularly among populations at greater risk due to their occupational environments. Recent research highlights various advancements in evidence-based methodologies across multiple disciplines, including healthcare, business, education, and policymaking. These studies emphasize the importance of systematic research approaches to enhance decision-making and minimize inefficiencies.

McCullin explored the integration of evidence-based management (EBMgt) into military judgment and decision-making (MJDM). By applying a novel search enhancement methodology, the study demonstrated that EBMgt can enhance the rigor and transparency of decision-making processes in military planning. The study highlighted that sufficient scholarship exists to address problem areas in military operations, suggesting that EBMgt is both feasible and pragmatic in this context [7]. Similarly, Lam et al. introduced "rapid Evidence Mapping" (rEM) as a systematic approach to accelerate literature reviews while maintaining methodological rigor. The study applied rEM to research on low-calorie sweeteners, identifying 297 relevant studies from 8,122 records. This approach was found to significantly reduce manual effort while maintaining accuracy compared to traditional evidence mapping methods. The study also identified research gaps, particularly in the assessment of dietary intake and appetite regulation among diabetic individuals [8].

Ferasso and Walter explored the role of case study methods in business research. The study emphasized the need for structured guidelines to define and analyze empirical evidence effectively. By applying forensic science principles to evidence analysis, the study proposed a framework to enhance the validity and reliability of case study findings [9]. Meanwhile, Hassanzadeh et al. developed an automated approach to quantify semantic similarity between clinical trial data. Their model, which combines ontology-based and vector-space techniques, achieved high accuracy in linking related clinical findings. The study demonstrated that semantic similarity measures could facilitate systematic reviews and meta-analyses by identifying related studies more efficiently [10].

Yu et al. examined the reliability of synthesizing early-stage research findings. The study found that while meta-analyses of initial studies can be useful for urgent decision-making, they often exhibit significant uncertainties. The findings highlighted the need for continuous updates and rigorous confidence assessments to ensure the reliability of synthesized evidence [11]. Additionally, Unal and Teskereci conducted a bibliometric analysis of evidence-based nursing research, revealing significant growth in this field over the past two decades. However, the study identified disparities in research output between developed and developing countries. The most common research topics included evidence dissemination, implementation barriers, and curriculum development for evidence-based nursing education [12].

The results solidify the role of serum CPK levels as a critical prognostic marker in assessing the severity of organophosphorus poisoning. The data not only support the correlation between CPK levels and clinical outcomes but also emphasize the importance of rapid medical response to reduce the severity of poisoning effects. These findings could guide future clinical protocols and interventions aimed at improving patient outcomes in cases of organophosphorus poisoning.

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