Predictors of Adverse Outcomes in Acute Poisoning in Children

Poisoning is one of the most common causes for hospitalization of pediatric patients, often requiring admission to an intensive care unit (ICU). Aim. To identify predictors of adverse outcomes in children with acute poisoning requiring ICU care. Materials and Methods. A single-center, observational, retrospective study was conducted involving 262 children with severe poisoning. The median age was 15 [13-16] years. Patients were divided into two groups based on the clinical course of the poisoning: favorable and unfavorable. Hospitalization outcomes included duration of mechanical ventilation (MV), length of ICU stay, presence of complications (aspiration syndrome, seizures, etc.), and in-hospital mortality. Results. The presence of toxic hepatitis/pancreatitis on admission increased the odds of adverse outcome by 4.63-fold, acute kidney injury by 5.32-fold, the need for MV by 14.34-fold, and aspiration pneumonia by 19.23-fold. The most significant markers of adverse outcomes during ICU care included shock (odds ratio OR=4.35), coagulopathy (OR=9.94), and hypocoagulation (OR=29.4). For assessing the severity of multiple organ dysfunction syndrome (MODS) in children with acute intoxication, the Marshall J. C. criteria showed the highest prognostic value (AUROC=0.894; sensitivity = 87.0%; specificity = 81.9%). A mathematical model was developed to predict the likelihood of adverse outcome in acute poisoning in children. The model includes 13 parameters: presence of pneumonia and seizures, need for MV, systolic and mean arterial pressure, catecholamine index, hemoglobin concentration, red and white blood cell counts, blood pH and glucose levels, SpO₂/FiO₂ ratio, and international normalized ratio (INR). The model demonstrated high predictive accuracy (accuracy=0.938; sensitivity=94.2%; specificity=92.5%; AUROC=0.981). Conclusion. Impaired consciousness, severe hypoxemia, coagulopathy and acute liver failure are the main markers of severe acute poisoning in children.