Abstract
Objectives
The prognosis of acutely poisoned patients is a significant concern for clinical toxicologists. In this study, we sought to determine the clinical and laboratory findings that can contribute to predicting the medical outcomes of poisoned patients admitted to intensive care units (ICUs).
Methods
This retrospective study was performed from January 2009 to January 2016 in the ICU of Vali-e-Asr Hospital in Birjand, Iran. We included all patients with the diagnosis of acute poisoning admitted to the ICU. Demographic data, laboratory results, the Sequential Organ Failure Assessment (SOFA), and acute physiology score + age points + chronic health points (APACHE) II, and the Simplified Acute Physiology Score (SAPS) II, and outcome were collected. Univariate analysis (Mann–Whitney or t-test), multiple logistic regression, receiver operating characteristics (ROC) curve analysis, and Pearson’s correlation test were performed using SPSS, STATA/SE 13.0, and Nomolog software programs.
Results
The multiple logistic regression analysis revealed that five factors were significant for predicting mortality including age (OR 95% CI: 1.1[1.05–1.12], p<0.001), Glasgow Coma Score (GCS) (OR 95% CI: 0.71[0.6–0.84], p<0.001), white blood cell (WBC) count (OR 95% CI: 1.1[1.01–1.12], p=0.04), serum sodium (Na) (OR 95% CI: 1.08[1.01–1.15], p=0.02), and creatinine levels (Cr) (OR 95% CI: 1.86 [1.23–2.81], p=0.003). We generated a five-variable risk-prediction nomogram which could both predict mortality risk and identify high-risk patients.
Conclusions
Age, GCS, WBC, serum creatinine, and sodium levels are the best prognostic factors for mortality in poisoned patients admitted to the ICU. The APACHE II score can discriminate between non-survivors and survivors. The nomogram developed in the current study can provide a more precise, quick, and simple analysis of risks, thereby enabling the users to predict mortality and identify high-risk patients.
Funding source: Birjand university of medical sciences
Acknowledgments
This paper is the result of an MD thesis by Dr. Firoozeh Jahani. It was supported by a grant from Birjand University of Medical Sciences. We wish to acknowledge the assistance of the Medical Toxicology and Drug Abuse Research Center (MTDRC) at Birjand University of Medical Sciences (BUMS). The authors appreciate Michael Wahl for his excellent review of the manuscript and editorial assistance.
Research funding: It was supported by a grant from Birjand University of Medical Sciences.
Author contributions: OM, AA, CH made substantial contributions to the study conception and design, acquisition of data, writing of the manuscript and critical revision, and final approval. SN, FJ, and SS made substantial contributions in drafting the manuscript and revising it critically for important intellectual content. AA and SN dealt with data acquisition, analysis, and interpretation and gave final approval to be published. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The Ethics Committee of Birjand University of Medical Sciences approved the study protocol.
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