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Seven- and thirty-day mortality in digoxin poisoning: Results from the DIGITOX study.
Supervía, August; Caballero-Bermejo, Antonio F; Puiguriguer, Jordi; Córdoba, Francisca; Martínez-Baladrón, Andrea; Callado, Francisco; Lobo-Antuña, Victoria; Fuentes, Elena; Molina-Samper, Valle; Vert, Susana; Ruíz-Ruíz, Francisco; Guijarro-Eguinoa, F Javier; Martín-Pérez, Beatriz; Olmos, Samuel; Ruiz-Antorán, Belén; Maza-Vera, María Teresa; Pallàs, Oriol; Climent, Benjamín; Igartua-Astibia, Maider; Gutiérrez, Edith; Nogué, Santiago; Ferrer-Dufol, Ana; Burillo-Putze, Guillermo.
Afiliación
  • Supervía A; Emergency Department, Hospital del Mar, Barcelona, Spain; Functional Clinical Toxicology Unit, Parc de Salut Mar, Barcelona, Spain; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Fundación Española de Toxicología Clínica, Spain.
  • Caballero-Bermejo AF; Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain; Internal Medicine Department, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: afcaballerobermejo@gmail.com
  • Puiguriguer J; Clinical Toxicology Unit, Emergency Department. Hospital Universitari Son Espases, Palma, Spain.
  • Córdoba F; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Fundación Española de Toxicología Clínica, Spain; Emergency Department, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
  • Martínez-Baladrón A; Emergency Department, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Callado F; Emergency Department, Clinical Toxicology Unit. Hospital Universitario de Burgos, Burgos, Spain.
  • Lobo-Antuña V; Internal Medicine Department, Clinical Toxicology Unit, Consorci Hospital General Universitari, Valencia, Spain.
  • Fuentes E; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
  • Molina-Samper V; Emergency Department, Hospital Universitario de Navarra, Pamplona, Spain.
  • Vert S; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Emergency Department, Hospital de Viladecans, Barcelona, Spain.
  • Ruíz-Ruíz F; Emergency Department, Hospital Clínico, Zaragoza, Spain.
  • Guijarro-Eguinoa FJ; Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain.
  • Martín-Pérez B; Emergency Department, Clinical Toxicology Unit, Hospital Universitario Río Ortega, Valladolid, Spain.
  • Olmos S; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Emergency Department, Consorci Hospitalari Parc Taulí de Sabadell, Barcelona, Spain.
  • Ruiz-Antorán B; Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain.
  • Maza-Vera MT; Emergency Department, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Pallàs O; Emergency Department, Hospital del Mar, Barcelona, Spain; Functional Clinical Toxicology Unit, Parc de Salut Mar, Barcelona, Spain.
  • Climent B; Internal Medicine Department, Clinical Toxicology Unit, Consorci Hospital General Universitari, Valencia, Spain.
  • Igartua-Astibia M; Emergency Department, Hospital de Viladecans, Barcelona, Spain.
  • Gutiérrez E; Internal Medicine Department, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Segovia de Arana, Madrid, Spain; Emergency Department, Hospital Universitario de Torrejón, Madrid, Spain.
  • Nogué S; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Fundación Española de Toxicología Clínica, Spain.
  • Ferrer-Dufol A; Fundación Española de Toxicología Clínica, Spain.
  • Burillo-Putze G; Fundación Española de Toxicología Clínica, Spain; Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain; Department of Physical Medicine and Pharmacology, Universidad de La Laguna, Tenerife, Spain.
Am J Emerg Med ; 81: 92-98, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38713933
ABSTRACT

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.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Digoxina Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Am J Emerg Med Año: 2024 Tipo del documento: Article País de afiliación: España

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Digoxina Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Am J Emerg Med Año: 2024 Tipo del documento: Article País de afiliación: España