Seven- and thirty-day mortality in digoxin poisoning: Results from the DIGITOX study - 03/06/24
, Jordi Puiguriguer g, Francisca Córdoba c, d, h, Andrea Martínez-Baladrón i, Francisco Callado j, Victoria Lobo-Antuña k, Elena Fuentes c, l, Valle Molina-Samper m, Susana Vert c, n, Francisco Ruíz-Ruíz o, F. Javier Guijarro-Eguinoa p, Beatriz Martín-Pérez q, Samuel Olmos c, r, Belén Ruiz-Antorán e, María Teresa Maza-Vera i, Oriol Pallàs a, b, Benjamín Climent k, Maider Igartua-Astibia n, Edith Gutiérrez s, t, Santiago Nogué c, d, Ana Ferrer-Dufol d, Guillermo Burillo-Putze d, u, vAbstract |
Background |
Digoxin poisonings are relatively common and potentially fatal, requiring immediate therapeutic intervention, with special attention to the patient's hemodynamic status and the presence of electrocardiographic and electrolytic disturbances.
Objective |
To identify factors associated with seven-day and thirty-day mortality in digoxin poisoning.
Design, settings and participants |
A retrospective, observational, multicenter study was conducted across 15 Hospital Emergency Departments (HED) in Spain. All patients over 18 years of age who presented to participating HEDs from 2015 to 2021 were included. The inclusion criteria encompassed individuals meeting the criteria for digoxin poisoning, whether acute or chronic.
Outcomes measure and analysis |
To identify independent factors associated with 7-day and 30-day mortality, a multivariate analysis was conducted. This analysis included variables of clinical significance, as well as those exhibiting a trend (p < 0.1) or significance in the bivariate analysis.
Main findings |
A total of 658 cases of digoxin poisoning were identified. Mortality rates were 4.5% (30 patients) at seven days and 11.1% (73 patients) at thirty days. Regarding 7-day mortality, the mean age of deceased patients was comparable to survivors (84.7 (8.9) vs 83.9 (7.9) years; p = ns). The multivariate analysis revealed that factors independently associated with 7-day mortality encompassed the extent of dependence assessed by the Barthel Index (BI 60–89 OR 0.28; 95% CI 0.10–0.77; p = 0.014 and BI>90 OR 0.22; 95% CI 0.08–0.63; p = 0.005), the identification of ventricular arrhythmias (OR 1.34; 95% CI 1.34–25.21; p = 0.019), and the presence of circulatory (OR 2.84; 95% CI 1.19–6.27; p = 0.019) and neurological manifestations (OR 2.67; 95% CI 1.13–6.27; p = 0.025). Factors independently associated with 30-day mortality encompassed extent of dependence (BI 60–89 OR 0.37; 95% CI 0.20–0.71; p = 0.003 and BI>90 OR 0.18; 95% CI 0.09–0.39; p < 0.001) and the identification of circulatory (OR 2.13; 95% CI 1.10–4.15; p = 0.025) and neurological manifestations (OR 2.39; 95% CI 1.25–3.89; p = 0.006).
Conclusions |
The study identifies the degree of dependency assessed by the Barthel Index and the presence of cardiovascular and neurological symptoms as independent predictors of both 7-day and 30-day mortality. Additionally, the detection of ventricular arrhythmia is also an independent factor for 7-day mortality.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Digoxin poisoning is a common, life-threatening issue. |
• | Frailty and comorbidities should be considered, given the high prevalence of this poisoning in the elderly. |
• | Identifying factors linked to mortality in the initial assessment warrants closer patient monitoring. |
Keywords : Fab fragments, Antidote, Digoxin, Poisoning, Seven-day mortality, Thirty-day mortality
Plan
Vol 81
P. 92-98 - juillet 2024 Retour au numéro
Article précédent
- Neuromuscular blocking agents during targeted temperature management for out-of-hospital cardiac arrest patients
- Akira Kawauchi, Makoto Aoki, Nobuya Kitamura, Takashi Tagami, Kei Hayashida, Shotaro Aso, Hideo Yasunaga, Mitsunobu Nakamura, on behalf of the SOS-KANTO 2017 Study Group
- Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial
- Sangeeta Sahoo, Nishit Kumar Sahoo, Upendra Hansda, Saroj Kumar Patro, Ajitesh Sahu, Chitta Ranjan Mohanty, Subhasree Das, Ijas Muhammed Shaji, Shri Hari Priya Behera
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?