Noseda Roberta, Franchi Matteo, Pagnamenta Alberto, Müller Laura, Dines Alison M, Giraudon Isabelle, Heyerdahl Fridtjof, Eyer Florian, Hovda Knut Erik, Liechti Matthias E, Miró Òscar, Vallersnes Odd Martin, Yates Christopher, Dargan Paul I, Wood David M, Ceschi Alessandro
Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy.
J Clin Med. 2023 Sep 14;12(18):5970. doi: 10.3390/jcm12185970.
This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014-2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15-1.99), along with polydrug use (aOR 1.39, 95% CI 1.22-1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26-1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66-3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74-0.99), cannabis (aOR 0.44, 95% CI 0.37-0.52), heroin (aOR 0.80, 95% CI 0.69-0.93), and amphetamine (aOR 0.65, 95% CI 0.54-0.78), as was the arrival to the ED during the night (8 p.m.-8 a.m., aOR 0.88, 95% CI 0.79-0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.
本研究旨在描述因急性娱乐性药物中毒而在急诊科就诊后入住重症监护病房的患者特征，并确定入住重症监护病房的决定因素。欧洲药物应急网络升级版（Euro-DEN Plus）在2014年至2021年期间开展了一项回顾性多中心匹配病例对照研究。病例为因急性娱乐性药物中毒而入住重症监护病房的急诊科就诊患者，对照由因急性娱乐性药物中毒而直接从急诊科医疗出院的急诊科就诊患者组成。通过多变量条件逐步逻辑回归分析评估入住重症监护病房的潜在决定因素，并使用多重插补法处理缺失数据。2014年至2021年期间，Euro-DEN Plus的3448例就诊涉及入住重症监护病房的患者（76.9%为男性；平均年龄33.2岁；标准差10.9岁）。急性娱乐性药物中毒后入住重症监护病房的决定因素包括患者年龄≥35岁（与≤18岁相比）（调整后的优势比[aOR]为1.51，95%置信区间[CI]为1.15至1.99），以及多药使用（aOR为1.39，95%CI为1.22至1.59）、同时摄入乙醇（aOR为1.44，95%CI为1.26至1.64）和使用γ-羟基丁酸/γ-丁内酯（GHB/GBL，aOR为3.08，95%CI为2.66至3.57）。相反，入住重症监护病房的几率较低与使用可卡因（aOR为0.85，95%CI为0.74至0.99）、大麻（aOR为0.44，95%CI为0.37至0.52）、海洛因（aOR为0.80，95%CI为0.69至0.93）和苯丙胺（aOR为0.65，95%CI为0.54至0.78）有关，夜间（晚上8点至早上8点）到达急诊科也是如此（aOR为0.88，95%CI为0.79至0.98）。这些发现值得进一步证实和研究，可能有助于更全面地理解急性娱乐性药物中毒患者入住重症监护病房背后的决策过程。
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