在西班牙加泰罗尼亚医院急诊服务中心就诊的地高辛中毒病例的即刻和 30 天死亡率。

Immediate and 30 days mortality in digoxin poisoning cases attended in the Hospital Emergency Services of Catalonia, Spain.

机构信息

Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, España. Unitat Funcional de Toxicología, Hospital Universitario del Mar, Barcelona, España. Universitat Autònoma de Barcelona, España. Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España. Grup de treball de Toxicologia de la SoCMUE (SoCMUETox), España.

Grup de treball de Toxicologia de la SoCMUE (SoCMUETox), España. Servicio de Urgencias, Hospital Clínic de Barcelona, España. Unidad de Toxicología, Hospital Clínic de Barcelona, España. Universitat de Barcelona, España.

出版信息

Emergencias. 2019 Feb;31(1):39-42.

PMID:30656872

Abstract

OBJECTIVES

Digoxin poisoning is a frequent reason for seeking emergency care. This study aimed to assess mortality related to digoxin poisoning.

MATERIAL AND METHODS

Descriptive observational study of digoxin poisonings attended in the emergency departments of 4 hospitals in Catalonia from 2013 through 2015. We gathered data relevant to the poisonings and recorded immediate and 30-day mortality. Factors possibly related to mortality were explored.

RESULTS

A total of 171 digoxin poisonings were attended. Seven (4.1%) were acute and 164 (95.9%) were chronic. The immediate and 30-day mortality rates were 6.4% and 13.4%, respectively. Bivariate analysis did not identify factors related to immediate mortality. However, the variables more often associated with 30-day mortality in this analysis were acute poisoning (after which 13% died vs 2.7% of those with chronic poisoning, P=.05), suicide attempts (8.7% of whom died vs 0.7%, P=.048), more compromised renal function (21.7% vs 9.5%, P=.037), fewer neurologic symptoms (4.3% vs 17.8% with more symptoms, P=.005), higher mean digoxin concentrations (4.7 mg/dL in those who died vs 3.7 mg/dL, P=.027), and a lower Barthel index (mean [SD] 49.1 [33.4] in those who died vs 70.3 [28.5]; P=.006). Logistic regression analysis identified serum digoxin concentration to be independently associated with immediate mortality. A lower Barthel index was associated with 30-day mortality.

CONCLUSION

Immediate mortality is related to a high digoxin concentration in serum, and 30-day mortality to a low Barthel index.

摘要

目的

地高辛中毒是寻求紧急医疗的常见原因。本研究旨在评估地高辛中毒相关死亡率。

材料与方法

对 2013 年至 2015 年期间在加泰罗尼亚 4 家医院急诊科就诊的地高辛中毒患者进行描述性观察研究。我们收集了与中毒相关的数据，并记录了即时和 30 天死亡率。探讨了可能与死亡率相关的因素。

结果

共收治 171 例地高辛中毒患者。7 例（4.1%）为急性中毒，164 例（95.9%）为慢性中毒。即时和 30 天死亡率分别为 6.4%和 13.4%。单变量分析未发现与即时死亡率相关的因素。然而，在本分析中与 30 天死亡率更相关的变量是急性中毒（13%的死亡患者 vs 慢性中毒患者的 2.7%，P=.05）、自杀企图（8.7%的死亡患者 vs 0.7%，P=.048）、更严重的肾功能不全（21.7% vs 9.5%，P=.037）、较少的神经症状（4.3% vs 17.8%，症状较多，P=.005）、更高的地高辛平均浓度（死亡患者为 4.7 毫克/分升，而非死亡患者为 3.7 毫克/分升，P=.027）和较低的巴氏量表评分（死亡患者的平均[标准差]为 49.1[33.4]，而非死亡患者为 70.3[28.5]，P=.006）。Logistic 回归分析发现血清地高辛浓度与即时死亡率独立相关。较低的巴氏量表评分与 30 天死亡率相关。