Seven- and thirty-day mortality in digoxin poisoning: Results from the DIGITOX study.

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.

Characteristics of digoxin toxicity attended in Spanish emergency departments according to type of poisoning and administration of digoxin antibodies: the DIGITOX study. / Características de las intoxicaciones por digoxina atendidas en diversos servicios de urgencias españoles en función del tipo de intoxicación y de la administración de anticuerpos antidigoxina: estudio DIGITOX.

OBJECTIVES: Digoxin toxicity accounts for a small percentage of poisonings attended by emergency departments. This study aimed to describe differences between acute and chronic digoxin toxicity and assess the use of digoxin-specific antibody fragments (digoxin-Fab) as an antidote. MATERIAL AND METHODS: Retrospective, observational, multicenter study in 15 hospital emergency departments in 8 Spanish autonomous communities in 7 years. We collected patient, clinical and treatment variables, and discharge destination. Patients were classified according to whether toxicity was acute or chronic and whether digoxin-Fab was administered or not. RESULTS: Twenty-seven acute and 631 chronic digoxin poisonings were attended. The mean (SD) patient age was 83.9 (7.9) years, and 76.9% were women. Patients with acute toxicity were younger (80.0 [12] years) than those with chronic toxicity (84.1 [7.7] years) (P .038), and accidental poisoning was less common (in 85.2% vs 100% in chronic toxicity; P .001). Cases of acute toxicity were also more serious (Poison Severity Score (29.6% vs 12.5% in chronic toxicity; P .001). Thirty-four patients were treated with digoxin-Fab (5.4%). These patients were younger (78.7 [11.5] years vs 84.2 (7.6) years), their toxicity was more often acute (in 20.6% vs 3.2% in chronic toxicity), more had attempted suicide (8.8% vs 0.2% with chronic toxicity), and more had severe symptoms (50% vs 11.2%) (P .001, all comparisons). Hospital admission was required for 76.1%. Overall, mortality was 11.4%. CONCLUSION: Chronic toxicity accounts for most digoxin poisoning cases, and most patients are women. Acute toxicity is more serious. Patients who required digoxin-Fab have more severe poisoning. Such patients usually have acute toxicity, and attempted suicide is more often the reason for the emergency.

OBJETIVO: Las intoxicaciones por digoxina representan un pequeño porcentaje de las intoxicaciones atendidas en urgencias. El objetivo de este estudio fue describir las diferencias entre intoxicaciones agudas y crónicas y evaluar la administración de su antídoto específico: los anticuerpos antidigoxina (AcAD). METODO: Estudio retrospectivo, observacional y multicéntrico en 15 servicios de urgencias hospitalarios de 8 comunidades autónomas durante 7 años. Se recogieron datos de filiación, clínica, tratamiento y destino al alta. Los pacientes se dividieron según era la intoxicación aguda o crónica y según recibían o no AcAD. RESULTADOS: Se recogieron 27 intoxicaciones agudas y 631 crónicas. La edad media fue de 83,9 (7,9) años, y el 76,9% eran mujeres. Los pacientes con intoxicación aguda tenían menor edad media (80,0 (12) vs 84,1 (7,7) años; p 0,038), y porcentaje de causa accidental (85,2% vs 100%; p 0,001) y mayor gravedad en la escala Poison Severity Score (29,6% vs 12,5%; p 0,001). Treinta y cuatro pacientes recibieron AcAD (5,4%) y constituyen un grupo de menor edad [78,7 (11,5) vs 84,2 (7,6); p 0,001], con mayor porcentaje de intoxicaciones agudas (20,6% vs 3,2%), intencionalidad suicida (8,8% vs 0,2%) y gravedad (50% vs 11,2%, p 0,001 en todas las comparaciones). El 76,1% precisó ingreso. La mortalidad fue del 11,4%. CONCLUSIONES: Las intoxicaciones por digoxina suelen ser crónicas y predominan en mujeres. Las intoxicaciones agudas son de mayor gravedad. Los pacientes que precisaron administración de AcAD tenían intoxicaciones más graves y mayor porcentaje de intoxicaciones agudas y con intencionalidad suicida.

Patients with drug-abuse poisoning with and without HIV infection: differential characteristics. / Intoxicaciones por drogas de abuso: características diferenciales en población VIH.

OBJECTIVES: Persons with HIV infection who use illicit drugs have higher morbidity and mortality rates than nonusers with or without HIV infection. The objetive were to detect differences between acute poisoning from illicit drugs in patients with and without HIV infection who are attended in hospital emergency departments, and to identify independent factors associated with a worse prognosis, defined by hospital admission or death. MATERIAL AND METHODS: Observational study in 2 hospitals between January 2017 and 31 December 2021. Included were patients with acute illicit drug poisoning with and without HIV infection. RESULTS: Information for 1132 patients was included. The mean (SD) ages of patients with and without HIV infection, respectively, were 38.9 (9.6) years and 32.6 (10.4) years. In patients with HIV, the main drugs used were opioids (279 [85.3%]), cocaine (226 [69.1%]), and amphetamines (153 [46.8%]. None in this group were on methadone substitution therapy for opioid addiction. In patients without HIV infection the main drugs were cocaine (372 [47.2%]) and cannabis (238 [33.8%]). Alcohol was used along with illicit drugs in 387 cases. Multivariate analysis showed that the only variables independently associated with a poor prognosis were HIV infection (odds ratio [OR], 2.19 [1.29-3.11], P .003), age (OR, 1.20 [1.01-1.05], P .003), and acute poisoning from benzodiazepines (OR, 3.48 [2.14-5.66], P .001). The area under the receiver operating characteristic curve of the model was 0.717. CONCLUSION: Certain characteristics distinguish the illicit drug use of patients with HIV infection. HIV infection, age, and the use of benzodiazepines are independently associated with a poor prognosis in acute poisonings.

OBJETIVO: La población VIH, consumidora de drogas de abuso (DA), tiene mayor morbimortalidad en relación con los no consumidores y no VIH. Se investiga si existen diferencias en las intoxicaciones agudas (IA) por DA, en pacientes VIH y no VIH atendidos en los servicios de urgencias hospitalarios (SUH), y se identifican factores independientes de mal pronóstico, definido por ingreso o fallecimiento. METODO: Estudio bicéntrico y observacional de 1 de enero de 2017 al 31 de diciembre de 2021. Se incluyeron pacientes VIH y no VIH atendido en dos SUH por intoxicación por DA. Se recogieron variables demográficas y la sustancia consumida. La variable de resultado principal fue mal pronóstico, definido como ingreso o muerte a los 30 días. RESULTADOS: Se recogieron 1.132 pacientes. La edad media de los pacientes VIH fue 39 ± 10 años, y 33 ± 10 años para los no VIH. En la población VIH predominaron los opiáceos 279 (85,3%) (ninguno de ellos estaba en tratamiento sustitutivo con metadona), la cocaína 226 (30,9%) y las anfetaminas 153 (69,1%), mientras que en la no VIH predominaron la cocaína 372 (47,2%) y el cannabis 238 (33,8%). El etanol se asoció con otras DA en 387 pacientes. El análisis multivariado mostró que las únicas variables independientes de mal pronóstico fueron el VIH [OR 2,19 (1,29-3,11), p 0,003], la edad [OR 1,20 (1,01-1,05), p 0,003], y la IA por benzodiacepinas (BDZ) [OR 3,48 (2,14-5,66), p 0,001], con un área bajo la curva de la característica operativa del receptor de este modelo de 0,717. CONCLUSIONES: Existen diferencias en las características de las IA en pacientes VIH. La infección VIH, la edad y el consumo de BZD son factores independientes de mal pronóstico en las IA.

Intoxicaciones por drogas de abuso: características diferenciales en población VIH / Patients with drug-abuse poisoning with and without HIV infection: differential characteristics

Objetivo: La población VIH, consumidora de drogas de abuso (DA), tiene mayor morbimortalidad en relación con los no consumidores y no VIH. Se investiga si existen diferencias en las intoxicaciones agudas (IA) por DA, en pacientes VIH y no VIH atendidos en los servicios de urgencias hospitalarios (SUH), y se identifican factores independientes de mal pronóstico, definido por ingreso o fallecimiento. Método: Estudio bicéntrico y observacional de 1 de enero de 2017 al 31 de diciembre de 2021. Se incluyeron pacientes VIH y no VIH atendido en dos SUH por intoxicación por DA. Se recogieron variables demográficas y la sustancia consumida. La variable de resultado principal fue mal pronóstico, definido como ingreso o muerte a los 30 días. Resultados: Se recogieron 1.132 pacientes. La edad media de los pacientes VIH fue 39 ± 10 años, y 33 ± 10 años para los no VIH. En la población VIH predominaron los opiáceos 279 (85,3%) (ninguno de ellos estaba en tratamiento sustitutivo con metadona), la cocaína 226 (30,9%) y las anfetaminas 153 (69,1%), mientras que en la no VIH predominaron la cocaína 372 (47,2%) y el cannabis 238 (33,8%). El etanol se asoció con otras DA en 387 pacientes. El análisis multivariado mostró que las únicas variables independientes de mal pronóstico fueron el VIH [OR 2,19 (1,29-3,11), p < 0,003], la edad [OR 1,20 (1,01-1,05), p < 0,003], y la IA por benzodiacepinas (BDZ) [OR 3,48 (2,14-5,66), p < 0,001], con un área bajo la curva de la característica operativa del receptor de este modelo de 0,717. Conclusiones: Existen diferencias en las características de las IA en pacientes VIH. La infección VIH, la edad y el consumo de BZD son factores independientes de mal pronóstico en las IA. (AU)

Objective: Persons with HIV infection who use illicit drugs have higher morbidity and mortality rates than nonusers with or without HIV infection. The objetive were to detect differences between acute poisoning from illicit drugs in patients with and without HIV infection who are attended in hospital emergency departments, and to identify independent factors associated with a worse prognosis, defined by hospital admission or death. Methods: Observational study in 2 hospitals between January 2017 and 31 December 2021. Included were patients with acute illicit drug poisoning with and without HIV infection. Results: Information for 1132 patients was included. The mean (SD) ages of patients with and without HIV infection, respectively, were 38.9 (9.6) years and 32.6 (10.4) years. In patients with HIV, the main drugs used were opioids (279 [85.3%]), cocaine (226 [69.1%]), and amphetamines (153 [46.8%]. None in this group were on methadone substitution therapy for opioid addiction. In patients without HIV infection the main drugs were cocaine (372 [47.2%]) and cannabis (238 [33.8%]). Alcohol was used along with illicit drugs in 387 cases. Multivariate analysis showed that the only variables independently associated with a poor prognosis were HIV infection (odds ratio [OR], 2.19 [1.29-3.11], P < .003), age (OR, 1.20 [1.01-1.05], P < .003), and acute poisoning from benzodiazepines (OR, 3.48 [2.14-5.66], P < .001). The area under the receiver operating characteristic curve of the model was 0.717. Conclusion: Certain characteristics distinguish the illicit drug use of patients with HIV infection. HIV infection, age, and the use of benzodiazepines are independently associated with a poor prognosis in acute poisonings. (AU)

Patología asociada al consumo de metanfetamina cristalizada (shabú) en un centro hospitalario de tercer nivel / Emergencies associated with shabu — crystal methamphetamine — in a tertiary care hospital

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Diferencias en los hallazgos clínicos en dos grupos de población inmigrante afecta de tuberculosis / Differences in clinical features of two immigrant populations with tuberculosis

Se realizó un estudio descriptivo para identificar posibles diferencias en la presentación clínica de la tuberculosis entre 2 grupos de población inmigrante. Se incluyeron 94 pacientes visitados en urgencias y que fueron diagnosticados de tuberculosis activa en el periodo 2006-12. Cuarenta y nueve pacientes era originarios de Asia Central (A) y 45 de Latinoamérica (LA). La edad media (años [DE]) fue de 35,3 (13) años en los procedentes de A por 33,9 (10) en los de LA. Existía un predominio de varones en asiáticos (40/49 vs. 25/45; p = 0,006). Los pacientes procedentes de LA tenían mayor porcentaje de tuberculosis pulmonar. Los pacientes de A vivían en condiciones de hacinamiento con mayor frecuencia. Los pacientes de LA tenían más antecedentes de seropositividad para el VIH. La mayoría recibió tratamiento cuádruple. Dos pacientes latinoamericanos eran resistentes a isoniazida

A study was performed to assess differences in the clinical presentation of tuberculosis between two groups of immigrants. Ninety-four patients seen in the emergency room for newly diagnosed tuberculosis between 2006 and 2012 were included. Forty-nine patients were from Asian countries and 45 from Latin America. Mean age [years (SD)] was 35.3 (13) in Asian patients and 33.9 (10) in Latin American patients. Asian subjects were predominantly male (40/49 vs 25/45; P=0.006). Patients from Latin American countries had a higher rate of pulmonary tuberculosis. A higher percentage of Asian patients lived in overcrowded conditions, whereas HIV infection was more frequent among Latin Americans. Most patients were treated with a quadruple regimen. Resistance to isoniazid was documented in two patients from Latin America

Differences in clinical features of two immigrant populations with tuberculosis.

A study was performed to assess differences in the clinical presentation of tuberculosis between two groups of immigrants. Ninety-four patients seen in the emergency room for newly diagnosed tuberculosis between 2006 and 2012 were included. Forty-nine patients were from Asian countries and 45 from Latin America. Mean age [years (SD)] was 35.3 (13) in Asian patients and 33.9 (10) in Latin American patients. Asian subjects were predominantly male (40/49 vs 25/45; P=0.006). Patients from Latin American countries had a higher rate of pulmonary tuberculosis. A higher percentage of Asian patients lived in overcrowded conditions, whereas HIV infection was more frequent among Latin Americans. Most patients were treated with a quadruple regimen. Resistance to isoniazid was documented in two patients from Latin America.

Factores predictivos de infección por el virus de la gripe H1N1 2009 en pacientes con síndrome gripal / Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome

Introducción: La técnica de reacción en cadena de la polimerasa en frotis nasofaríngeo es uno de los mejores métodos para la detección de virus gripales. El objetivo de este estudio es conocer el porcentaje de frotis nasofaríngeos positivos durante la pandemia de gripe de 2009 y determinar si existe algún factor predictor de positividad para el virus H1N1 2009. Métodos: Estudio retrospectivo de todos los pacientes que consultaron en Urgencias por síndrome gripal entre el 15 de julio y el 15 de diciembre de 2009 a los que se realizó un frotis nasofaríngeo. Se identificaron aquellos casos en los que el frotis estaba correctamente solicitado. Se dividieron en dos grupos según la positividad para el virus H1N1 2009. Resultados: Se realizó un frotis nasofaríngeo a 362 pacientes. En 87 casos estaba incorrectamente indicado. De los 275 restantes, fue positivo en 141. Los pacientes con frotis positivo eran más jóvenes (36,1(15) años vs 42,3(18); p=0,002), tenían menor recuento de leucocitos, neutrófilos y linfocitos, menor valor de proteína C reactiva (5,15(5) vs 10,5(12); p<0,001) y menor incidencia de infiltrados radiológicos (20,5% vs 33%; p=0,036). La regresión logística identificó la edad, una proteína C reactiva baja y un recuento linfocitario bajo como factores independientes de infección por el virus H1N1 2009. Conclusiones: En pacientes con síndrome gripal, el porcentaje de positividades del frotis para detectar H1N1 2009 se sitúa en el 50%. La edad, los niveles de proteína C reactiva y el recuento linfocitario son factores independientes para predecir el resultado(AU)

Introduction: Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity. Material and Methods: A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus. Results: Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P = 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5 [12] mg/dL, P = 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P = 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab. Conclusions:About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity(AU)