Development of a risk prediction nomogram for disposition of acute toxic exposure patients to intensive care unit.
acute poisoning
intensive care unit admission
nomogram
prognostic model
risk stratification
Journal
Basic & clinical pharmacology & toxicology
ISSN: 1742-7843
Titre abrégé: Basic Clin Pharmacol Toxicol
Pays: England
ID NLM: 101208422
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
12
01
2021
accepted:
26
05
2021
pubmed:
13
6
2021
medline:
4
1
2022
entrez:
12
6
2021
Statut:
ppublish
Résumé
Early risk stratification of acutely poisoned patients is essential to identify patients at high risk of intensive care unit (ICU) admission. We aimed to develop a prognostic model and risk-stratification nomogram based on the readily accessible clinical and laboratory predictors on admission for the probability of ICU admission in acutely poisoned patients. This retrospective cohort study included adult patients with acute toxic exposure to a drug or a chemical substance. Patients' demographic, toxicologic, clinical and laboratory data were collected. Among the 1260 eligible patients, 180 (14.3%) were admitted to the ICU. We developed a generalized prognostic model for predicting ICU admission in patients with acute poisoning. The predictors included the Glasgow coma scale, oxygen saturation, diastolic blood pressure, respiratory rate and blood bicarbonate concentration. The model displayed excellent discrimination and calibration (optimistic-adjusted area under the curve = 0.924 and optimistic-adjusted Hosmer and Lemeshow test = 0.922, respectively) when internally validated. Additionally, we developed prognostic models that determine ICU admission in patients with specific poisonings. Furthermore, we constructed risk-stratification nomograms that rank the probability of ICU admission in these patients. The developed risk-stratification nomograms help decision-making regarding ICU admission in acute poisonings. Future external validation in independent cohorts is necessary before clinical application.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
256-267Informations de copyright
© 2021 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).
Références
Mehrpour O, Akbari A, Jahani F, et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med. 2018;18(1):30-30. https://doi.org/10.1186/s12873-018-0181-6
Balaraju R, Vallepalli C, Sattari SR, et al. Demographic trends and outcome of acute poisoning in a rural tertiary care hospital of Nalgonda District, Telangana. Indian J Public Health Res Dev. 2020;11(7):652-656. https://doi.org/10.37506/ijphrd.v11i7.10160
Organization WH. World Health Organization. Guidelines for poison control. World Health Organization; 1997. Accessed April 17, 2021.
Boedeker W, Watts M, Clausing P, Marquez E. The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review. BMC Public Health. 2020;20(1):1875-1889. https://doi.org/10.1186/s12889-020-09939-0
Chandran J, Krishna B. Initial management of poisoned patient. Indian J Crit Care Med. 2019;23(Suppl 4):S234-S240. https://doi.org/10.5005/jp-journals-10071-23307
Brandenburg R, Brinkman S, de Keizer NF, Kesecioglu J, Meulenbelt J, de Lange DW. The need for ICU admission in intoxicated patients: a prediction model. Clin Toxicol (Phila). 2017;55(1):4-11. https://doi.org/10.1080/15563650.2016.1222616
van Beusekom I, Bakhshi-Raiez F, de Keizer NF, de Lange DW. The healthcare costs of intoxicated patients who survive ICU admission are higher than non-intoxicated ICU patients: a retrospective study combining healthcare insurance data and data from a Dutch national quality registry. BMC Emerg Med. 2019;19(1):6-6. https://doi.org/10.1186/s12873-019-0224-7
Glass G, Hartka TR, Keim-Malpass J, Enfield KB, Clark MT. Dynamic data in the ED predict requirement for ICU transfer following acute care admission. J Clin Monit Comput. 2020;35(3):1-9. https://doi.org/10.1007/s10877-020-00500-3
Liu V, Kipnis P, Rizk NW, Escobar GJ. Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. J Hosp Med. 2012;7(3):224-230. https://doi.org/10.1002/jhm.964
Khalifa H, Lashin H. Predictors for intensive care unit admission in acute theophylline intoxicated patients. Ain Shams J Forensic Med Clin Toxicol. 2018;31(2):77-86. https://doi.org/10.21608/ajfm.2018.15880
Böll R, Romanek K, Schmoll S, et al. Independent validation of the ICU requirement score in a cohort of acutely poisoned adults. Clin Toxicol (Phila). 2018;56(7):664-666. https://doi.org/10.1080/15563650.2017.1401635
Kuo S-C, Hung S-H, Wang H-Y, et al. Chinese nomogram to predict probability of positive initial prostate biopsy: a study in Taiwan region. Asian J Androl. 2013;15(6):780-784. https://doi.org/10.1038/aja.2013.100
Lionte C, Sorodoc V, Jaba E, Botezat A. Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents: an observational study. Medicine (Baltimore). 2017;96(12):e6404. https://doi.org/10.1097/MD.0000000000006404
Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med. 2015;162(1):55-63. https://doi.org/10.7326/m14-0697
Kocaşaban DÜ, Arslan V, Günaydin YK, Okumuş M. The intensive care unit admission criteria for patients with poisoning. J Eurasian J Crit Care. 2019;1(2):59-64.
Yu J-H, Weng Y-M, Chen K-F, Chen S-Y, Lin C-C. Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study. BMC Health Serv Res. 2012;12(1):262. https://doi.org/10.1186/1472-6963-12-262
Hoffman RS, Nelson LS, Goldfrank L, et al. Initial evaluation of the patient: vital signs and toxic syndromes. In: Flomenbaum NE, ed. Gold Frank's Toxicologic Emergencies. 9th ed. New York: McGraw-Hill Professional; 2011:36-41.
Braitberg G. Drugs and antidotes in acute intoxication. In: Ronco C, Bellomo R, Kellum JA, Ricci Z, eds. Critical Care Nephrology. Third ed. Elsevier; 2019:574-588.
Kirkwood BR, Sterne JAC. Essential Medical Statistics. Blackwell; 2003.
Xu Y, Goodacre R. On splitting training and validation set: a comparative study of cross-validation, bootstrap and systematic sampling for estimating the generalization performance of supervised learning. J Anal Test. 2018;2(3):249-262. https://doi.org/10.1007/s41664-018-0068-2
Efron B, Tibshirani R. An Introduction to the Bootstrap. Chapman and Hall; 1993.
Shao J. Bootstrap model selection. J Am Stat Assoc. 1996;91(434):655-665.
Han K, Song K, Choi BW. How to develop, validate, and compare clinical prediction models involving radiological parameters: study design and statistical methods. Korean J Radiol. 2016;17(3):339-350. https://doi.org/10.3348/kjr.2016.17.3.339
Smith GC, Seaman SR, Wood AM, Royston P, White IR. Correcting for optimistic prediction in small data sets. Am J Epidemiol. 2014;180(3):318-324. https://doi.org/10.1093/aje/kwu140
Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21(1):128-138. https://doi.org/10.1097/EDE.0b013e3181c30fb2
van Calster B, van Hoorde K, Vergouwe Y, et al. Validation and updating of risk models based on multinomial logistic regression. Diagn Progn Res. 2017;1(2):1-14. https://doi.org/10.1186/s41512-016-0002-x
Pavlou M, Ambler G, Seaman SR, et al. How to develop a more accurate risk prediction model when there are few events. BMJ. 2015;351:h3868. https://doi.org/10.1136/bmj.h3868
Zlotnik A, Abraira V. A general-purpose nomogram generator for predictive logistic regression models. The Stata J. 2015;15(2):537-546. https://doi.org/10.1177/1536867X1501500212
Assaf A, Abd El Kareem M, Hasb Elnabi M. Outcome prediction in acutely intoxicated patients admitted to intensive care unit. Ain Shams J Forensic Med Clin Toxicol. 2019;33(2):16-23. https://doi.org/10.21608/ajfm.2019.30445
Parikh RB, Obermeyer Z, Navathe AS. Regulation of predictive analytics in medicine. Science. 2019;363(6429):810-812. https://doi.org/10.1126/science.aaw0029
Conway R, Byrne D, O'Riordan D, Silke B. Patient risk profiling in acute medicine: the way forward? Qjm. 2015;108(9):689-696. https://doi.org/10.1093/qjmed/hcv014
Farzaneh E, Ghobadi H, Akbarifard M, et al. Prognostic factors in acute aluminium phosphide poisoning: a risk-prediction nomogram approach. Basic Clin Pharmacol Toxicol. 2018;123(3):347-355. https://doi.org/10.1111/bcpt.13005
Nelson LS, Lewin NA, Howland M, Hoffman R. Use of the intensive care unit. In: Kirk MA, ed. Goldfrank's Toxicologic Emergencies. 9th ed. McGraw-Hill Companies; 2015:148-155.
Cournane S, Conway R, Byrne D, O'Riordan D, Silke B. Predicting outcomes in emergency medical admissions using a laboratory only nomogram. Comput Math Methods Med. 2017;2017:1-8, 5267864. https://doi.org/10.1155/2017/5267864
Fu AZ, Cantor SB, Kattan MW. Use of nomograms for personalized decision-analytic recommendations. Med Decis Making. 2010;30(2):267-274. https://doi.org/10.1177/0272989x09342278
Sencan A, Adanir T, Aksun M, Karahan N, Anan G. The relationship of demographic and etiological characteristics with mortality in acutely poisoned patients admitted to intensive care unit. J Turk Anesth Rean Der Dergisi. 2009;37(2):80-85.
Clark D, Murray DB, Ray D. Epidemiology and outcomes of patients admitted to critical care after self-poisoning. J Intensive Care Soc. 2011;12(4):268-273.
Taghaddosinejad F, Sheikhazadi A, Yaghmaei A, Mehrpour O, Schwake L. Epidemiology and treatment of severe poisoning in the intensive care unit: lessons from a one-year prospective observational study. J Clin Toxicol S. 2012;1:2161.
Fernando SM, Reardon PM, Ball IM, et al. Outcomes and costs of patients admitted to the intensive care unit due to accidental or intentional poisoning. J Intensive Care Med. 2020;35(4):386-393. https://doi.org/10.1177/0885066617754046
Sulaj Z, Prifti E, Demiraj A, Strakosha A. Early clinical outcome of acute poisoning cases treated in intensive care unit. Med Arch (Sarajevo Bosnia Herzegovina). 2015;69(6):400-404. https://doi.org/10.5455/medarh.2015.69.400-404
Yaylaci S, Genc AB, Demir MV, Cinemre H, Tamer A. Retrospective evaluation of patients at follow-up with acute poisoning in intensive care unit. Niger J Clin Pract. 2016;19(2):223-226. https://doi.org/10.4103/1119-3077.164340
Shokrzadeh M, Hoseinpoor R, Jafari D, et al. A ten-year study of drug poisoning cases admitted to the intensive care unit of 5 Azar Hospital in Gorgan, Iran. J Clin Basic Res. 2019;3(2):8-13.
Hosseini SF, Forouzesh M, Maleknia M, Valiyari S, Maniati M, Samimi A. The molecular mechanism of aluminum phosphide poisoning in cardiovascular disease: pathophysiology and diagnostic approach. Cardiovasc Toxicol. 2020;20(5):454-461. https://doi.org/10.1007/s12012-020-09592-4
Nazima S, Bashir Y, Nabi S, Bashir N. Intensive care management of organophosphorus poisoning patients: an experience from tertiary care center. Int J Adv Med. 2018;5(2):257-264.
Oladunjoye AO, Oladunjoye OO, Olubiyi O, Yee MR, Espiridion ED. Predictors and outcomes of invasive mechanical ventilation in opioid overdose hospitalization in the United States. Cureus. 2020;12(8):e9788. https://doi.org/10.7759/cureus.9788
Ibrahim NAM. An up-to-date review of digoxin toxicity and its management. Int J Res Pharm Pharm Sci. 2019;4(3):59-64.
Koeijers J, Verhoeven C, Boersma H, van Mook W. Treatment of theophylline intoxication using continuous venovenous haemofiltration. Neth J Crit Care. 2008;12:32-34.
Sulaj Z, Drishti A, Çeko I, Gashi A, Vyshka G. Fatal aluminum phosphide poisonings in Tirana (Albania), 2009-2013. DARU: J Faculty Pharm, Tehran University of Medical Sciences. 2015;23(1):8-8. https://doi.org/10.1186/s40199-015-0090-0
Rajbanshi LK, Arjyal B, Mandal R. Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in eastern Nepal. Indian J Crit Care Med Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine. 2018;22(10):691-696. https://doi.org/10.4103/ijccm.IJCCM_207_18
Kocaşaban DÜ, Arslan V, Günaydin YK, Okumuş M. The intensive care unit admission criteria for patients with poisoning. Eurasian J Crit Care. 1(2):59-64.
Bjørn M, Simonsen JW, Mogensen CB. A combination of clinical parameters and blood-gas analysis identifies patients at risk of transfer to intensive care upon arrival to the Emergency Department. Eur J Emerg Med. 2016;23(4):305-310. https://doi.org/10.1097/mej.0000000000000269
Maignan M, Pommier P, Clot S, et al. Deliberate drug poisoning with slight symptoms on admission: are there predictive factors for intensive care unit referral? A three-year retrospective study. Basic Clin Pharmacol Toxicol. 2014;114(3):281-287. https://doi.org/10.1111/bcpt.12132
El-Sarnagawy G, Hafez A. Comparison of different scores as predictors of mechanical ventilation in drug overdose patients. Hum Exp Toxicol. 2017;36(6):539-546.
Oreby M, Maklad A, Shihab N, Kassem H. Prediction of outcome of acutely intoxicated patients admitted to intensive care unit in Mansoura-Dakhlia Governorate-Egypt. Ain Shams J Forensic Med Clin Toxicol. 2016;26(1):140-150.
El-Sarnagawy GN. Predictive factors of mortality in acute aluminum phosphide poisoning: 5 years retrospective study in Tanta Poison Control Unit. Ain Shams J Forensic Med Clin Toxicol. 2017;29:58-67.
Sun IO, Yoon HJ, Lee KY. Prognostic factors in cholinesterase inhibitor poisoning. Med Sci Monit. 2015;21:2900-2904. https://doi.org/10.12659/msm.894287
Anjana D, Neeta D. Predictors of respiratory failure in acute organophosphorus compound poisoning. IJHRMLP. 2019;5(1):15-18.
Dijkland S, Retel Helmrich I, Steyerberg E. Validation of prognostic models: challenges and opportunities. J Emerg Crit Care Med. 2018;2(91):1-4.