Evaluation of various scoring systems as predictors of the need for intensive care unit admission and other adverse outcomes among patients with acute clozapine poisoning.

Autor:	Lashin HI; Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt., Sharif AF; Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Jazyk:	angličtina
Zdroj:	Toxicology research [Toxicol Res (Camb)] 2023 May 04; Vol. 12 (3), pp. 468-479. Date of Electronic Publication: 2023 May 04 (Print Publication: 2023).
DOI:	10.1093/toxres/tfad029
Abstrakt:	Acute clozapine poisoning (ACP) is frequently reported worldwide. We evaluated the efficacy of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS) as predictors for intensive care unit (ICU) admission, mechanical ventilation (MV), mortality, and length of hospital stay in patients with ACP. A retrospective cohort study was conducted using records of patients diagnosed with ACP from January 2017 to June 2022 and admitted to an Egyptian poison control center. Analyzing 156 records showed that all assessed scores were significant predictors of the studied outcomes. The PSS and APACHE II score showed the highest area under the curve (AUC) as ICU admission predictors with insignificant variations. The APACHE II score showed the best discriminatory power in predicting MV and mortality. Nevertheless, MEWS exhibited the highest odds ratio (OR) as an ICU predictor (OR = 2.39, and 95% confidence interval = 1.86-3.27) and as a mortality predictor (OR = 1.98, and 95% confidence interval = 1.16-4.41). REMS and MEWS were better predictors of length of hospital stay compared with the APACHE II score. The simpler, lab-independent nature and the comparable discrimination but higher odds ratio of MEWS compared with APACHE II score justify MEWS' superior utility as an outcome predictor in ACP. We recommend using either the APACHE II score or MEWS, depending on the availability of laboratory investigations, resources, and the case's urgency. Otherwise, the MEWS is a substantially feasible, economical, and bedside alternative outcome predictor in ACP. (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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