To explore the relationship between hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) and pulmonary fibrosis and prognosis in patients with acute severe organophosphorus pesticide poisoning (ASOPP).

Seventy-five ASOPP patients admitted to our emergency department from July 2022 to March 2025 were selected as subjects and divided into a control group (38 cases) and an observation group (37 cases) based on the treatment method. The control group received HP treatment, while the observation group received HP combined with CVVH treatment. Levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), Procollagen Ⅲ amino terminal propeptide (PⅢNP), Collagen Type Ⅳ (CIV), and transforming growth factor-beta 1 (TGF-β1) were compared between the two groups. Clinical efficacy and mortality were recorded during follow-up.

There were no statistically significant differences in CRP, IL-6, and TNF-α levels between the two groups before treatment (P>0.05). After treatment, the levels of CRP, IL-6, and TNF-α in the observation group were lower than those in the control group (P<0.05). There were no statistically significant differences in PⅢNP, CIV, and TGF-β1 levels between the two groups before treatment (P>0.05). After treatment, the levels of PⅢNP, CIV, and TGF-β1 in the observation group were lower than those in the control group (P<0.05). One case (2.70%) of pulmonary fibrosis occurred in the observation group, which was lower than the 8 cases (21.05%) in the control group (χ²= 8.656, P=0.003). Multivariate logistic regression analysis showed that HP+ CVVH treatment was a protective factor for reducing the risk of pulmonary fibrosis (OR=0.057, 95%CI: 0.004~0.754, P=0.030), and the pre-treatment SOFA score was a risk factor for pulmonary fibrosis (OR=1.628, 95%CI: 1.072~2.474, P=0.022). The CHE activity recovery time in the observation group was 4.00 (3.00, 7.00) days, shorter than 6.00 (4.00, 9.00) days in the control group (P=0.035). After 28 days of outpatient follow-up, there were 26 survivors (68.42%) and 12 deaths (31.58%) in the control group; there were 33 survivors (89.19%) and 4 deaths (10.81%) in the observation group (P=0.028). The incidence of intermediate syndrome after hemoperfusion in the observation group was 2 cases (5.41%), lower than 8 cases (21.05%) in the control group (χ²=3.972, P=0.046). The incidence of organ injury in the observation group was 8 cases (21.62%), which was lower than that in the control group (14 cases, 36.84%) (χ²=2.095, P=0.148).

HP combined with CVVH treatment helps reduce the incidence of pulmonary fibrosis and mortality in ASOPP patients, improving prognosis.