Exploring the pentraxin-3 as a prognostic biomarker in paraquat poisoning: a systematic-narrative hybrid review

Paraquat is a commonly used pesticide that is highly toxic to humans and leads to fatal lung fibrosis upon consumption. Due to its rapid clearance from the bloodstream, there are no reliable biomarkers for the diagnosis and prognosis of paraquat intoxication. Pentraxin 3 (PTX3), an acute-phase inflammatory mediator, has emerged as a potential biomarker, particularly in the context of lung injury and fibrosis. This review aimed to assess the prognostic value of the level of PTX3 in predicting clinical outcomes in patients with paraquat poisoning and to evaluate the correlation between PTX3 levels and the severity of poisoning.

A comprehensive literature search was conducted using PubMed, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Scopus, CROSSREF, and Google Scholar. The included studies were observational (cohort or case-control), involving human subjects with confirmed paraquat poisoning, and reported PTX3 levels related to clinical outcomes. Data on PTX3 expression, disease severity, and prognostic correlations were extracted.

Two primary studies were performed. PTX3 levels were significantly elevated in non-survivors compared to survivors and were positively correlated with serum paraquat levels and disease severity. PTX3 levels peaked between 12 and 24 h post-ingestion and maintained a prognostic value over subsequent days. A PTX3 cut-off of 8.9 ng/mL was associated with higher mortality, with moderate sensitivity and specificity.

PTX3 is a promising prognostic biomarker for paraquat poisoning, particularly in cases where traditional markers are unreliable. Due to the limited sample size, a multicenter study is recommended to validate the role of PTX3 in clinical and forensic settings.