The Significance of Serum Transaminases As Predictors of Mortality in Paraquat Poisoning: A Systematic Review and Meta-Analysis
Author(s)
Kaur H1, Chandran V2, Rashid M2, Kunhikatta V3, Thunga G2
1Manipal Academy of Higher Education, Dist. Udupi, KA, India, 2Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, KA, India, 3Dept. of Pharmcy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, KA, India
OBJECTIVES: To systematically review the literature and assess the prognostic value of serum transaminases, aspartate transaminase (AST) and alanine transaminase (ALT) in predicting mortality in paraquat (PQ) poisoning by systematic review and meta-analysis.
METHODS: Databases PubMed, Scopus, Embase, Web of Science and Cochrane Library were searched from inception to November 2022. The observational studies reporting either AST or ALT values in survivors and non-survivors and/or assessing their prediction accuracy for mortality in PQ poisoning were included. Meta-DiSc 1.4 software was used to estimate the prediction accuracy outcomes, viz. pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). Threshold effect was determined by Spearman’s correlation coefficient. Summary receiver operating characteristic curve (SROC) was generated for area under the curve (AUC) and standard error (SE) estimation by Stata SE 17 (trial version) software. The Quality in Prognostic Studies tool was used for risk of bias assessment.
RESULTS: 35 studies with 5433 patients were included in the systematic review, from which, 6 were included in meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR for AST (n=3) for predicting death in PQ poisoning was estimated to be 78% (95%CI 67%-87%), 71% (95%CI 61%-80%), 2.74 (95%CI 0.32-23.75), 0.52 (95%CI 0.06-4.55) and 5.16 (95%CI 0.08-334.32), respectively. The pooled sensitivity, specificity, PLR, NLR and DOR for ALT (n=5) was 42% (95%CI 33%-51%), 47% (95%CI 40%-54%), 1.06 (95%CI 0.55-2.04), 0.89 (95%CI 0.51-1.56) and 1.20 (95%CI 0.32-4.46), respectively. Spearman’s correlation coefficient indicated threshold effect. The AUC (SE) of SROC curve was 0.75 (0.27) and 0.53 (0.11) for AST and ALT, respectively.
CONCLUSIONS: The current evidence indicated that AST had a better sensitivity and specificity than ALT. Moreover, AST depicted a greater AUC value, thus, indicating a fair prognostic ability of AST in predicting death in PQ poisoning.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
CO116
Topic
Clinical Outcomes, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment, Literature Review & Synthesis, Meta-Analysis & Indirect Comparisons
Disease
Injury & Trauma, No Additional Disease & Conditions/Specialized Treatment Areas