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Clinical Characteristics and Early Risk Factors for Toxic Encephalopathy in Acute Diquat Poisoning
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摘要: 目的 分析急性敌草快中毒并发中枢神经系统损伤（ central nervous systeminjury，CNSI）的临床特征，并筛查早期危险因素，以期为降低敌草快中毒并发CNSI病死率提供理论依据。方法 收集2019年10月至2024年10月安徽医科大学附属阜阳人民医院急诊科收治的急性敌草快中毒患者临床资料，根据并发症将患者分为CNSI组和非CNSI组，比较两组患者临床特征，对差异存在统计学意义的指标进行二元Logistic回归分析，筛选影响急性敌草快中毒并发CNSI的独立危险因素，并绘制受试者工作特征（ receiver operatingcharacteristic，ROC）曲线，分析各危险因素对患者发生CNSI的预测价值。结果 共纳入63例符合入选标准的患者，其中18例（ 28.57%）死亡，26例（ 41.27%）并发CNSI，CNSI的发生距离毒物摄入时间为15.5（9.8,31.3） h。CNSI组患者病死率、呼吸支持治疗和抗休克治疗比例均高于非CNSI组（P均＜0.05）。多因素二元Logistic回归分析显示，敌草快浓度（≥549.95 ng/mL）和APACHEⅡ评分为急性敌草快中毒并发CNSI的独立危险因素（P均＜0.05），二者均对CNSI具有预测价值，且联合预测价值优于单一指标（P均＜0.05）。结论 CNSI是急性敌草快中毒的致命性并发症，病死率高，敌草快浓度（≥549.95 ng/mL）和APACHEⅡ评分是CNSI发生的独立危险因素，二者联合预测CNSI发生的价值更优。Abstract: Objective To analyze the clinical characteristics of acute diquat poisoning complicated by central nervous system injury (CNSI) and identify early risk factors, aiming to provide a theoretical basis for reducing mortality in diquat poisoning with CNSI. Methods Clinical data from patients with acute diquat poisoning admitted to the Emergency Department of Fuyang People's Hospital Affiliated to Anhui Medical University between October 2019 and October 2024 were retrospectively analyzed. Patients were divided into CNSI and non-CNSI groups based on complications. Clinical features were compared between groups, and variables with statistical significance were subjected to binary logistic regression to identify independent risk factors for CNSI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of these factors. Results A total of 63 eligible patients were included, with 18 deaths (28.57%) and 26 cases (41.27%) complicated by CNSI. The median time from diquat ingestion to CNSI onset was 15.5 (9.8-31.3) hours. The CNSI group exhibited significantly higher mortality rates and required more frequent respiratory support and anti-shock therapy than the non-CNSI group (P <0.05 for all). Multivariate binary logistic regression identified diquat plasma concentration (≥ 549.95 ng/mL) and APACHE II score as independent risk factors for CNSI (P <0.05). Both factors demonstrated predictive value for CNSI, with combined use showing superior predictive performance compared to individual indicators (P <0.05). Conclusion CNSI is a fatal complication of acute diquat poisoning with high mortality. Diquat plasma concentration (≥ 549.95 ng/mL) and APACHE II score are independent risk factors for CNSI, and their combined application enhances predictive accuracy. These findings underscore the importance of early risk stratification and targeted interventions in high-risk populations.
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Keywords:
- diquat /
- poisoning /
- central nervous system injury /
- clinical characteristics /
- risk factors
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