Puncture frequency, coagulopathy, and liver injury as independent risk factors for bleeding in acute diquat poisoning after enhanced blood purification therapy.

OBJECTIVE

To identify independent risk factors for bleeding and propose preventive strategies in acute diquat poisoning (ADP) patients undergoing enhanced blood purification therapy (EBPT).

METHODS

In this retrospective study, a total of 297 ADP patients (May 2022-April 2024) were categorized into a conventional treatment (n=124) and EBPT (n=173) groups according to their treatment regimens. Clinical data, coagulation/liver function, and bleeding events were compared between the two groups. Logistics regression analysis was applied to identify independent risk factors for bleeding. COX regression model was used to explore the risk factors affecting survival prognosis. Kaplan-Meier method was used to draw survival analysis curve.

RESULTS

The EBPT group had a significantly higher bleeding incidence (45.05% vs. 4.23%, P<0.05), predominantly at puncture sites. Independent bleeding risk factors included puncture frequency, degree of poisoning, prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), white blood cell count (WBC), elevated alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (P<0.05). Bleeding patients had a higher 28-day mortality rate (50.00% vs. 18.95%, P<0.05) and longer ICU stays. Cox analysis confirmed that ALT, puncture frequency, poisoning severity, and bleeding were significant survival predictors (P<0.05).

CONCLUSION

EBPT increases bleeding risk in ADP patients, mainly due to procedural factors and organ dysfunction. Optimizing puncture techniques and closely monitoring coagulation and liver function may improve patient outcomes.