Objective: To investigate the clinical features and prognosis risk factors of the elderly and youth patients with acute severe poisoning.
Methods: Adult patients with acute severe poisoning in the emergency intensive care unit (EICU) of Nanjing Drum Tower Hospital from January 2008 to December 2017 were enrolled. The patients were divided into the elderly group (age ≥ 60 years) and the youth group (16 years ≤ age < 60 years), the clinical data of the two groups were analyzed. The patients were divided into survival group and death group according to the prognosis of 28-day, binary multivariate Logistic regression was used to analyze the risk factors of mortality of the elderly and youth patients; receiver operating characteristic curve (ROC) was used to assess the predictive value of acute physiology and chronic health evaluation II (APACHE II) in mortality of youth patients.
Results: A total of 343 patients with acute severe poisoning were included, 89 in the elderly group and 254 in the youth group. (1) Clinical features: compared with the youth group, the elderly group had higher proportion of basic diseases included hypertension, type 2 diabetes and coronary heart disease, higher the initial APACHE II scores at admission, higher the proportion of invasive mechanical ventilation and respiratory failure, and longer the length of EICU stay and the length of hospital stay. The main poisoning causes of elderly and youth patients were suicide (58.43%, 83.86%) and accidents (38.20%, 13.39%). The most common poisoning types of elderly patients were sedative hypnotics (23.60%) and organophosphorus pesticides (22.47%); the youth patients were mainly paraquat (42.52%) and organophosphorus pesticide (17.32%). There were 28 patients died (31.46%) in the elderly group and the cause of death were respiratory failure (53.57%), circulatory failure (32.14%) and multiple organ dysfunction syndrome (MODS, 14.29%). There were 67 patients died (26.38%) in the youth group and the cause of death were respiratory failure (59.70%), MODS (20.90%) and circulatory failure (19.40%). (2) Risk factors of deaths: the APACHE II score, incidence of acute kidney injury (AKI) and MODS in the elderly death group were significantly higher than those in the elderly survival group. Logistic regression analysis showed that AKI was the independent risk factor for death in elderly patients [odds ratio (OR) = 8.449, 95% confidence interval (95%CI) = 2.347-30.410, P = 0.001]. The proportion of female, APACHE II score, and the incidence of AKI, respiratory failure and MODS in the youth death group were significantly higher than those in the youth survival group. Logistic regression analysis showed that APACHE II score (OR = 1.175, 95%CI = 1.081-1.277, P = 0.001), AKI (OR = 34.470, 95%CI = 11.681-101.722, P = 0.001) and MODS (OR = 3.834, 95%CI = 1.264-11.636, P = 0.018) were the independent factors for death in the youth patients. (3) Predictive value: the initial APACHE II score was useful for predicting prognosis of youth patients with acute severe poisoning. The APACHE II score to predict the death of the area under the ROC curve (AUC) was 0.744 (95%CI = 0.681-0.806, P = 0.001); the cut-off was 5, the sensitivity was 92.54%, the specificity was 51.34%, the positive predictive value was 65.53%, the negative predictive value was 87.31%, the positive likelihood ratio was 1.902, and the negative likelihood ratio was 0.145.
Conclusions: Patients with acute severe poisoning have their own clinical characteristics. To reduce the morbidity and improve the prognosis, we should strengthen the pre-hospital management and optimize the clinical treatment process.