Selected Liver Markers in Predicting the Severity of Organophosphate and Carbamate Poisoning

Intentional ingestion of organophosphate (OP) and carbamate is a significant health issue worldwide. It causes adverse health effects on the liver. This study aimed to determine liver transaminases (AST and ALT) and bilirubin levels to assess the severity of poisoning in patients with acute OP and carbamate poisoning.

A descriptive cross-sectional study was conducted on patients admitted to a selected hospital in Sri Lanka with acute OP and carbamate poisoning. The severity of poisoning was measured by RBC cholinesterase and Peradeniya Organophosphorus Poisoning scale (POP), where six clinical features were assessed based on a 3-point scale. A score of 0-3 was considered mild, 4-7 to be moderate, and 8-11 to be severe poisoning. Liver parameters such as AST, ALT, and total and direct bilirubin were measured.

Among the 188 screened patients, 166 were recruited. Majority were males (112, 67.5%). Kruskal-Wallis test showed significant differences in AST and ALT on admission and AST on discharge, across POP groups ((χ ² (2, n = 166) = 26.48, p ≤ 0.001), (χ ² (2, n = 166) = 14.31, p=0.001), and (χ ² (2, n = 157) = 11.34, p=0.003), respectively)). Mann-Whitney U test showed significantly higher AST and ALT in the moderate POP group compared to the mild POP group (AST: U = 1709, z = -4.50, p ≤ 0.001, r = 0.36; ALT: U = 2114, z = -3.04, p=0.002, r = 0.26) on admission. In addition, the treatment outcomes (duration of hospital stay and duration of ventilator assistance) were significantly correlated (p ≤ 0.001) with the severity of poisoning and serum AST and ALT at the time of admission.

AST and ALT levels on admission and AST level at discharge showed significant correlations with the severity of poisoning. Treatment outcomes significantly correlated with the severity of poisoning and serum AST and ALT levels.