C-reactive protein and Red cell distribution width as a prognostic marker for outcome of Organophosphorus poisoning

organophosphate (OP) compounds are frequently used as pesticides in countries like ours ,where a great deal of agricultural activities are involved.The ease of availability of the OP compounds has resulted in a gradual increase in unintentional and suicidal poisoning,mainly in developing countries.The world health organization (WHO) has estimated that more than 300 million acute pesticide poisoning occur worldwide each year and most of these cases are due to OP intoxication.The mortality rate of acute OP poisoning is 10%-20% and WHO has estimated that 2,00000 people die each year from pesticide poisoning.Elevated Red cell distribution Width is found in systemic inflammation and oxidative stress.The exact underlying mechanism is not well understood .Oxidative stress is defined as disturbance of the balance between the production of free radicals and the antioxidant capacity of the body.More severe the poisoning more is the production of free radicals and more oxidative stress.Increased oxidative stress contributes to an increase in lipid per oxidation and decrease in the phospholipids content of the erythrocyte membrane.As a result the erythrocyte membrane is damaged and erythrocytes lose their integrity.The lifespan of mature erythrocytes is shortened.In OP poisoning ,there is acute inflammation and increased oxidative stress that can lead to a change in the structure and size of the circulating erythrocyte .Hence it is expected that RDW levels may be increased in OP poisoning and thus can aid in prognosis.CRP is an acute phase reactant that can be used for monitoring of infection or autoimmune disease.In patients with such diseases,cytokine,mainly interleukin-6,stimulates the liver cells and promotes the productions of CRP.In acute OP Poisoning,toxins may cause lesions in tissues and organs in the body, leading to increased plasma CRP levels.We intend to evaluate  utility  of these two routinely available and inexpensive tests in prognostication of OP poisoning.