Biomarkers of Inflammation and Inflammation-Related Indexes upon Emergency Department Admission Are Predictive for the Risk of Intensive Care Unit Hospitalization and Mortality in Acute Poisoning: A 6-Year Prospective Observational Study

Abstract

Patients poisoned with drugs and nonpharmaceutical substances are frequently admitted from the emergency department (ED) to a medical or ICU department. We hypothesized that biomarkers of inflammation and inflammation-related indexes based on the complete blood cell (CBC) count can identify acutely poisoned patients at increased risk for ICU hospitalization and death. We performed a 6-year prospective cohort study on 1548 adult patients. The demographic data, the levels of hs-CRP (high-sensitivity C-reactive protein), CBC, and inflammation-related indexes based on CBC counts were collected upon admission and compared between survivors and nonsurvivors, based on the poison involved. Both a multivariate logistic regression model with only significant univariate predictors and a model including univariate predictors plus each log-transformed inflammation-related indexes for mortality were constructed. The importance of the variables for mortality was graphically represented using the nomogram. hs-CRP (odds ratio (OR), 1.38; 95% CI, 1.16–1.65, p < 0.001 for log-transformed hs-CRP), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly associated with the risk of ICU hospitalization, after multivariable adjustment. Only RDW, NLR, and monocyte-lymphocyte ratio (MLR) were significantly associated with mortality. The predictive accuracy for mortality of the models which included either NLR (AUC 0.917, 95% CI 0.886-0.948) or MLR (AUC 0.916, 95% CI 0.884-0.948) showed a high ability for prognostic detection. The use of hs-CRP, RDW, NLR, and MLR upon ED admission are promising screening tools for predicting the outcomes of patients acutely intoxicated with undifferentiated poisons.

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

“…Most commonly, these hematological indices have been used in oncology, where elevated values for the NLR and PLR can be predictors of poor outcomes in patients with non-small cell lung cancers [2], gastrointestinal cancers [3,4] and breast cancer [5], as well as several other malignancies. Other applications relate to myocardial diseases and cardiogenic shock [6][7][8]; infectious diseases, as predictors of sepsis and bacteremia [9,10]; and acute poisoning, as predictors for ICU admission and mortality [11].…”

Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects

“… 59 , 60 In patients poisoned with undifferentiated drugs and nonpharmaceutical substances, the need for ICU hospitalization is correlated with higher levels of biomarkers, within 24 hours of exposure, such as high-sensitivity C-reactive protein, red cell distribution width, neutrophil–lymphocyte ratio, and monocyte–lymphocyte ratio. 61 …”

“…These insecticides irreversibly inhibit acetylcholinesterase leading to a buildup of acetylcholine and excess stimulation of the CNS, muscarinic and nicotinic receptors. 61 , 99 …”

Endogenous humoral determinants of vascular endothelial dysfunction as triggers of acute poisoning complications

“…In their consequences, these complications may surpass the direct damaging effect of xenobiotics. Biomarkers of inflammation and inflammation-related indexes such as high-sensitivity C-reactive protein, and those based on the complete blood cell count, are promising screening tools for predicting the outcomes of patients acutely intoxicated with undifferentiated poisons (Lionte et al, 2021). Indexes of the systemic inflammatory response syndrome, accompanied with fibrinolysis and coagulation, correlated positively with the severity of outcomes of antipsychotic poisoning (Zhang et al, 2020).…”