Admission Blood Glucose as a Predictor of Mortality and Severe Outcomes in Acute Organophosphorus Poisoning: A Systematic Review and Meta-Analysis

Abstract

Acute organophosphorus poisoning remains a major toxicologic emergency and cause of morbidity and mortality, especially in agricultural and resource-limited settings. Early identification of patients at risk of deterioration is essential. Admission blood glucose has been proposed as a simple prognostic marker, but the evidence has not been synthesized in a focused review. This study aims to evaluate the association between admission blood glucose and mortality and severe clinical outcomes in acute organophosphorus poisoning. A systematic review and meta-analysis was conducted using PubMed and a supplementary Google Scholar search. PubMed yielded 157 records, and the first 200 Google Scholar records sorted by relevance were also screened. After title and abstract screening, full-text review, and exclusion of ineligible reports, 5 observational studies were included in the qualitative synthesis and 3 studies in the quantitative synthesis. The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation or respiratory failure and poisoning severity. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel random-effects model. Results from the included studies showed that elevated admission glucose was associated with significantly increased odds of mortality (OR 5.68, 95% CI 3.55-9.07; I² = 0%) and mechanical ventilation or respiratory failure (OR 4.46, 95% CI 3.02-6.59; I² = 0%). Narrative synthesis of the remaining studies also supported the association between higher admission glucose and greater poisoning severity. These findings point towards admission glucose being a simple and clinically useful early prognostic marker, although the available evidence is limited by observational design and variation in glycemic cut-offs.