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, 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.

中文翻译：

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急诊科入院时炎症和炎症相关指标的生物标志物可预测重症监护病房住院和急性中毒死亡率的风险：一项为期 6 年的前瞻性观察研究

药物和非药物物质中毒的患者经常从急诊科 (ED) 进入医疗或 ICU 部门。我们假设基于全血细胞 (CBC) 计数的炎症生物标志物和炎症相关指标可以识别急性中毒患者的 ICU 住院和死亡风险增加。我们对 1548 名成年患者进行了一项为期 6 年的前瞻性队列研究。在入院时收集人口统计数据、hs-CRP（高敏 C 反应蛋白）水平、CBC 和基于 CBC 计数的炎症相关指标，并根据所涉及的毒物在幸存者和非幸存者之间进行比较。构建了仅具有显着单变量预测因子的多变量逻辑回归模型和包括单变量预测因子以及每个对数转换的死亡率炎症相关指标的模型。使用列线图以图形方式表示变量对死亡率的重要性。hs-CRP（优势比 (OR)，1.38；95% CI，1.16–1.65，经多变量调整后，对数转换后的 hs-CRP、红细胞分布宽度 (RDW)、中性粒细胞-淋巴细胞比 (NLR) 和血小板-淋巴细胞比 (PLR) 与 ICU 住院风险显着相关。只有 RDW、NLR 和单核细胞-淋巴细胞比率 (MLR) 与死亡率显着相关。包括 NLR (AUC 0.917, 95% CI 0.886-0.948) 或 MLR (AUC 0.916, 95% CI 0.884-0.948) 在内的模型对死亡率的预测准确性显示出很高的预后检测能力。在 ED 入院时使用 hs-CRP、RDW、NLR 和 MLR 是预测急性未分化毒物中毒患者预后的有前景的筛查工具。