Amirabadizadeh Alireza, Nakhaee Samaneh, Jahani Firoozeh, Soorgi Sima, Hoyte Christopher O, Mehrpour Omid
Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Islamic Republic of Iran.
Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Islamic Republic of Iran.
Drug Metab Pers Ther. 2020 Sep 28. doi: 10.1515/dmdi-2020-0108.
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.
目的 急性中毒患者的预后是临床毒理学家极为关注的问题。在本研究中，我们试图确定有助于预测入住重症监护病房（ICU）的中毒患者医疗结局的临床和实验室检查结果。方法 本回顾性研究于2009年1月至2016年1月在伊朗比尔詹德的瓦利 - 阿斯尔医院ICU进行。我们纳入了所有入住ICU且诊断为急性中毒的患者。收集人口统计学数据、实验室检查结果、序贯器官衰竭评估（SOFA）、急性生理评分 + 年龄分 + 慢性健康分（APACHE）II、简化急性生理评分（SAPS）II以及结局。使用SPSS、STATA/SE 13.0和Nomolog软件程序进行单因素分析（曼 - 惠特尼检验或t检验）、多因素逻辑回归、受试者工作特征（ROC）曲线分析以及Pearson相关性检验。结果 多因素逻辑回归分析显示，有五个因素对预测死亡率具有显著意义，包括年龄（OR 95% CI：1.1[1.05 - 1.12]，p < 0.001）、格拉斯哥昏迷评分（GCS）（OR 95% CI：0.71[0.6 - 0.84]，p < 0.001）、白细胞（WBC）计数（OR 95% CI：1.1[1.01 - 1.12]，p = 0.04）、血清钠（Na）（OR 95% CI：1.08[1.01 - 1.15]，p = 0.02）以及肌酐水平（Cr）（OR 95% CI：1.86 [1.23 - 2.81]，p = 0.003）。我们生成了一个五变量风险预测列线图，它既能预测死亡风险，又能识别高危患者。结论 年龄、GCS、WBC、血清肌酐和钠水平是入住ICU的中毒患者死亡率的最佳预后因素。APACHE II评分能够区分非幸存者和幸存者。本研究中开发的列线图可以提供更精确、快速且简单的风险分析，从而使使用者能够预测死亡率并识别高危患者。
Zotero 插件