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.

Publisher: Hindawi Pub. Corp Country of Publication: United States NLM ID: 8604127 Publication Model: eCollection Cited Medium: Internet ISSN: 1875-8630 (Electronic) Linking ISSN: 02780240 NLM ISO Abbreviation: Dis Markers Subsets: MEDLINE

Publication: 2015- : New York, NY : Hindawi Pub. Corp.
Original Publication: Chichester ; New York : Wiley, c1983-

Biomarkers/*analysis ; Emergency Service, Hospital/*statistics & numerical data ; Hospitalization/*statistics & numerical data ; Inflammation/*diagnosis ; Intensive Care Units/*statistics & numerical data ; Poisoning/*mortality; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Blood Platelets/pathology ; C-Reactive Protein/metabolism ; Erythrocyte Indices ; Female ; Follow-Up Studies ; Humans ; Inflammation/complications ; Inflammation/immunology ; Inflammation/metabolism ; Lymphocytes/pathology ; Male ; Middle Aged ; Neutrophils/pathology ; Poisoning/etiology ; Poisoning/metabolism ; Poisoning/pathology ; Prognosis ; Prospective Studies ; Survival Rate ; Young Adult

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.
Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper.
(Copyright © 2021 Catalina Lionte et al.)

Clin Biochem. 2018 Feb;52:131-136. (PMID: 29132766)
Bull World Health Organ. 2012 Jun 1;90(6):436-443A. (PMID: 22690033)
Br J Surg. 2015 Feb;102(3):148-58. (PMID: 25627261)
Am J Emerg Med. 2014 Sep;32(9):1132. (PMID: 24985946)
Clin Toxicol (Phila). 2017 Jan;55(1):4-11. (PMID: 27644313)
Sci Rep. 2016 Nov 08;6:36235. (PMID: 27824090)
Clin Toxicol (Phila). 2013 Jan;51(1):29-34. (PMID: 23170819)
Am J Cardiol. 2008 Mar 15;101(6):747-52. (PMID: 18328833)
Semin Oncol. 2010 Feb;37(1):23-6. (PMID: 20172360)
Clin Toxicol (Phila). 2019 Dec;57(12):1220-1413. (PMID: 31752545)
J Expo Sci Environ Epidemiol. 2012 May-Jun;22(3):243-7. (PMID: 22377683)
J Cell Physiol. 2019 Feb;234(2):1794-1802. (PMID: 30070689)
Cardiovasc Toxicol. 2019 Aug;19(4):334-343. (PMID: 30610672)
Int Arch Med. 2012 Jan 26;5(1):2. (PMID: 22281066)
PLoS One. 2016 Dec 9;11(12):e0167000. (PMID: 27936006)
Medicine (Baltimore). 2019 Sep;98(37):e17199. (PMID: 31517877)
Curr Cardiol Rev. 2019;15(4):274-282. (PMID: 30799790)
Turk Kardiyol Dern Ars. 2013 Apr;41(3):199-206. (PMID: 23703554)
Am J Emerg Med. 2014 Jul;32(7):743-6. (PMID: 24768665)
Hum Exp Toxicol. 2019 Oct;38(10):1127-1131. (PMID: 31215240)
Physiol Meas. 2015 May;36(5):939-53. (PMID: 25856296)
Am J Emerg Med. 2013 Jun;31(6):989-90. (PMID: 23588034)
Am J Emerg Med. 2016 May;34(5):840-4. (PMID: 26947364)
Afr Health Sci. 2013 Mar;13(1):129-36. (PMID: 23658579)
Cancer Manag Res. 2021 Feb 12;13:1395-1405. (PMID: 33603483)
J Basic Clin Physiol Pharmacol. 1995;6(3-4):205-28. (PMID: 8852268)
Exp Ther Med. 2016 Mar;11(3):806-810. (PMID: 26997996)
Turk J Emerg Med. 2018 Jul 14;18(4):158-161. (PMID: 30533559)
Basic Clin Pharmacol Toxicol. 2019 Apr;124(4):500-510. (PMID: 30372579)
Crit Care Med. 2002 Aug;30(8):1782-6. (PMID: 12163793)
Am J Emerg Med. 2013 Jun;31(6):991-2. (PMID: 23602743)
Am J Emerg Med. 2014 Dec;32(12):1476-80. (PMID: 25264245)
Neurol Sci. 2017 Oct;38(10):1859-1863. (PMID: 28779361)
J Emerg Med. 2014 Sep;47(3):286-93. (PMID: 24958695)
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020 Feb 20;38(2):137-140. (PMID: 32306679)

0 (Biomarkers)
9007-41-4 (C-Reactive Protein)

Date Created: 20210830 Date Completed: 20220117 Latest Revision: 20220117

20221213

PMC8390135

10.1155/2021/4696156

34457088