Risk factors for death in patients with acute diquat poisoning

doi:10.5847/wjem.j.1920-8642.2025.040

Abstract

Abstract:

BACKGROUND: In recent years, with the ban on paraquat, the use of diquat (DQ) as a substitute has significantly increased, leading to a corresponding increase in DQ poisoning cases. This study aimed to identify relevant risk factors affecting patient prognosis and provide a basis for the assessment of patient prognosis.

METHODS: Patients with DQ poisoning were included from September 2020 to December 2023, and data were extracted from their electronic medical records on the first day of hospitalization. Least Absolute Shrinkage and Selection Operator (LASSO) regression and binary multivariate logistic regression analyses were performed on the collected clinical data to identify risk factors.

RESULTS: A total of 117 patients with acute DQ poisoning were included, and were categorized into two groups based on their 28-day outcomes: survival group (n=67) and non-survival group (n=50). There were no statistically significant differences between the two groups in terms of sex, lymphocyte count, platelet-to-lymphocyte ratio, or blood purification rate (P>0.05). The analysis revealed that age (odds ratio [OR] 1.094, 95% confidence interval [95% CI] 1.022-1.171), blood drug concentration (OR 3.659, 95% CI 1.846-7.252), lactate (OR 1.686, 95% CI 1.062-2.678), neutrophil-to-lymphocyte ratio (NLR) (OR 1.101, 95% CI 1.017-1.192), albumin (OR 1.275, 95% CI 1.107-1.468), and aspartate aminotransferase (AST) (OR 1.027, 95% CI 1.005-1.051) were the risk factors for mortality.

CONCLUSION: This study identified key risk factors for 28-day mortality in patients with acute DQ poisoning, which may provide valuable guidance for clinical treatment, particularly for emergency physicians.

Key words: Acute diquat poisoning, Prognosis, Risk factor, Retrospective study

Qing Tang, Hongxin Wang, Hao Wang, Jiaqi Xu, Xin Luo, Shuxin Hua, Lijun Wang, Yanfen Chai. Risk factors for death in patients with acute diquat poisoning[J]. World Journal of Emergency Medicine, 2025, 16(3): 225-230.

Figures/Tables 5

Table 1.

Figure 1.

Figure 2.

Table 2.

Figure 3.

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Parameters	Survival group (n=67)	Non-survival group (n=50)	t/Z/χ²	P-value
Age, years, n (%)			26.289	0.000
≤20	25 (37.31)	2 (4.00)
21-40	28 (41.79)	29 (58.00)
41-60	14 (20.90)	15 (30.00)
≥61	0 (0.00)	4 (8.00)
Gender, n (%)			1.577	0.209
Female	36 (53.73)	21 (42.00)
Male	31 (46.27)	29 (58.00)
Blood drug concentration, mg/L, median (IQR)	1.7 (1.1, 2.2)	3.7 (2.6, 4.5)	-7.141	<0.001
Lactate, mmol/L, median (IQR)	1.7 (1.3, 2.6)	4.3 (2.4, 6.6)	-5.823	<0.001
WBC, ×10⁹/L, median (IQR)	14.6 (11.2, 18.5)	20.2 (16.6, 27.4)	-4.614	<0.001
RBC, ×10⁹/L, median (IQR)	4.6 (4.2, 5.1)	5.1 (4.4, 5.5)	-2.187	0.029
NEUT, ×10⁹/L, median (IQR)	12.1 (8.9, 16.6)	17.3 (14.1, 25.2)	-4.229	<0.001
LYC, ×10⁹/L, median (IQR)	1.2 (0.9, 1.9)	1.2 (0.7, 1.8)	-0.394	0.694
NLR, median (IQR)	9.6 (5.4, 15.2)	15.6 (6.0, 29.1)	-2.562	0.010
PLT, ×10⁹/L, mean±standard deviation	277.90±85.83	245.74±69.08	2.174	0.032
PLR, median (IQR)	213.2 (144.3, 285.7)	175.3 (136.0, 339.9)	-0.738	0.460
TP, g/L, median (IQR)	74.6 (66.1, 82.7)	79.4 (71.7, 90.7)	-2.267	0.023
ALB, g/L, median (IQR)	43.8 (39.3, 49.0)	47.7 (43.6, 50.3)	-2.353	0.019
Cr, μmol/L, median (IQR)	59.7 (49.0, 74.3)	97.0 (75.0, 135.5)	-4.998	<0.001
TBIL,μmol/L, median (IQR)	13.2 (8.3, 20.2)	18.0 (14.4, 25.3)	-3.201	0.001
BUN, mmol/L, median (IQR)	5.0 (3.9, 6.3)	5.6 (4.7, 7.4)	-2.543	0.011
ALT, U/L, median (IQR)	25.0 (17.0, 39.0)	40.0 (20.5, 107.8)	-3.351	0.001
AST, U/L, median (IQR)	25.0 (20.0, 31.0)	43.5 (26.0, 154.3)	-4.661	<0.001
SII, median (IQR)	2237.1 (1280.6, 4429.6)	3325.9 (1618.8, 6494.2)	-1.791	0.073
Blood purification, n (%)			2.130	0.144
No	8 (11.94)	11 (22.00)
Yes	59 (88.06)	39 (78.00)

Variables	AUC	95% CI	Sensitivity	Specificity	Cut-off	P-value
Age	0.705	0.613-0.797	0.96	0.373	20.0	<0.001
Blood drug concentration	0.887	0.823-0.950	0.86	0.806	2.2	<0.001
Lactate	0.815	0.738-0.893	0.70	0.806	2.8	<0.001
NLR	0.639	0.534-0.743	0.50	0.776	16.2	0.010
ALB	0.627	0.524-0.731	0.72	0.552	44.5	0.019
AST	0.752	0.664-0.840	0.62	0.761	31.0	<0.001
Combined indicators	0.953	0.920-0.985	1.00	0.791	0.2	<0.001

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