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. 2014 Sep 17;2(2):98-104.
doi: 10.1002/ams2.77. eCollection 2015 Apr.

Independent risk factors for a complicated hospital course in intensive care unit overdose patients

Takehiko Tarui  1 , Kei Yoshikawa  1 , Yasuhiko Miyakuni  1 , Yasuhiko Kaita  1 , Nao Tamada  1 , Taketo Matsuda  1 , Hiroshi Miyauchi  1 , Kenji Yamada  1 , Takeaki Matsuda  1 , Yoshihiro Yamaguchi  1
Affiliations

Independent risk factors for a complicated hospital course in intensive care unit overdose patients

Takehiko Tarui et al. Acute Med Surg. .

Abstract

Aim: The purpose of the present study was to identify risk factors associated with a complicated hospital course in overdose patients admitted to the intensive care unit.

Methods: A total of 335 overdose patients were retrospectively studied in the surgical and medical intensive care unit of an academic tertiary hospital. Factors possibly associated with a complicated hospital course were evaluated. Complicated hospital course was defined as the occurrence of pneumonia, rhabdomyolysis, decubitus ulcer, nerve palsy, prolonged intubation, prolonged hospitalization, or death.

Results: Of the 335 overdose patients, 93 (27.8%) had a complicated hospital course. Complicated hospital course was found to be associated with a high number of ingested pills (median, 135 [interquartile range, 78-240] versus 84 [53-134] tablets, P < 0.0001), low Glasgow Coma Scale score on admission (7 [3-11] versus 13 [8-15], P < 0.0001), and a high serum lactate level on admission (1.8 [1.0-3.0] versus 1.4 [0.9-2.0] mg/dL, P < 0.01) on univariate analysis of these factors in patients with and without a complicated hospital course. The independent risk factors for a complicated hospital course identified on multivariate analysis were a high number of ingested pills (≥100 tablets), low admission Glasgow Coma Scale score (<9), and high serum lactate on admission (≥2.0 mg/dL). The probability of a complicated hospital course for patients with 0, 1, 2, or all 3 independent risk factors were 7%, 22%, 40%, and 81%, respectively.

Conclusion: The total number of ingested pills, admission Glasgow Coma Scale score, and serum lactate level on admission are predictive of a complicated hospital course in overdose patients admitted to the intensive care unit.

Keywords: Complications; drug overdose; lactate; toxicology/poisoning; triage.

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Figures

Figure 1
Figure 1
Main types of drug ingested by overdose patients admitted to the intensive care unit of Kyorin University Hospital, Tokyo, Japan from January 2010 to December 2012 (n = 335). The drug with the largest quantity of ingested pills was shown in each case. NSAID, non‐steroidal anti‐inflammatory drugs; SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin and norepinephrine reuptake inhibitors.
Figure 2
Figure 2
Sensitivity and specificity curves with corresponding optimal cut‐off values for the three independent factors associated with a complicated hospital course in overdose patients admitted to the intensive care unit of Kyorin University Hospital, Tokyo, Japan from January 2010 to December 2012 (n = 335). GCS, Glasgow Coma Scale.
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References

    1. Okumura Y, Shimizu S, Ishikawa KB, Matsuda S, Fushimi K, Ito H. Characteristics, procedural differences, and costs of inpatients with drug poisoning in acute care hospitals in Japan. Gen. Hosp. Psychiatry 2012; 34: 681–685. - PubMed
    1. Hifumi T, Otomo Y, Yoshioka H, Yamaguchi J, Ishidou K, Honma M. Analysis of a prehospital triage protocol and severity assessment of patients with acute drug intoxication. J. Jpn. Soc. Emerg. Med. 2009; 12: 543–547. (In Japanese.)
    1. Akobeng AK. Understanding diagnostic test 3: receiver operating characteristic curves. Acta Paediatr. 2007; 96: 644–647. - PubMed
    1. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit. Care Med. 2004; 32: 88–93. - PubMed
    1. Christ A, Arranto CA, Schindler C et al Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive Care Med. 2006; 32: 1423–1427. - PubMed

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