Management of intoxicated patients – a descriptive outcome analysis of 4,267 ICU patients

Management of intoxicated patients – a descriptive outcome analysis of 4,267 ICU patients

Epidemiology, Poisoning, Hospital mortality, Intensive care units, Critical illness

Introduction: Intoxications are common in intensive care units (ICUs). The number of causative substances is large,
mortality usually low. This retrospective cohort study aims to characterize diferences of intoxicated compared to
general ICU patients, point out variations according to causative agents, as well as to highlight diferences between
survivors and non-survivors among intoxicated individuals in a large-scale multi-center analysis.
Methods: A total of 105,998 general ICU patients and 4,267 individuals with the admission diagnoses “overdose”
and “drug toxicity” from the years 2014 and 2015 where included from the eICU Collaborative Research Database. In
addition to comparing these groups with respect to baseline characteristics, intensive care measures and outcome
parameters, diferences between survivors and non-survivors from the intoxication group, as well as the individual
groups of causative substances were investigated.
Results: Intoxicated patients were younger (median 41 vs. 66 years; p<0.001), more often female (55 vs. 45%;
p<0.001), and normal weighted (36% vs. 30%; p<0.001), whereas more obese individuals where observed in the other
group (37 vs. 31%; p<0.001). Intoxicated individuals had a signifcantly lower mortality compared to general ICU
patients (1% vs. 10%; aOR 0.07 95%CI 0.05-0.11; p<0.001), a fnding which persisted after multivariable adjustment
(aOR 0.17 95%CI 0.12-0.24; p<0.001) and persisted in all subgroups. Markers of disease severity (SOFA-score: 3 (1-5) vs.
4 (2-6) pts.; p<0.001) and frequency of vasopressor use (5 vs. 15%; p<0.001) where lower, whereas rates of mechanical ventilation where higher (24 vs. 26%; p<0.001) in intoxicated individuals. There were no diferences with regard
to renal replacement therapy in the frst three days (3 vs. 4%; p=0.26). In sensitivity analysis (interactions for age, sex,
ethnicity, hospital category, maximum initial lactate, mechanical ventilation, and vasopressor use), a trend towards
lower mortality in intoxicated patients persisted in all subgroups.
Conclusion: This large-scale retrospective analysis indicates a signifcantly lower mortality of intoxicated individuals
compared to general ICU patients.

Richard Rezar, Christian Jung, Behrooz Mamandipoor, Clemens Seelmaier, Thomas K. Felder, Michael Lichtenauer, Sarah Wernly, Samanta M. Zwaag, Dylan W. De Lange, Bernhard Wernly and Venet Osmani

BMC Emergency Medicine

(2022) 22:38

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