Urinary 8-oxo-7,8-dihydroguanosine as a potential biomarker for the prognosis of acute poisoning patients in the emergency Intensive-care unit: a prospective observational study

Acute poisoning remains a significant cause of admission to the emergency intensive-care unit (EICU). Despite a reduced mortality rate, attention is increasingly focusing on the impact of post-intensive-care syndrome (PICS) on readmission. Due to the significant role of oxidative stress (OS) in the pathological mechanisms of poisoning, 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodGuo) may hold great potential as biomarkers for OS biomarkers to evaluate the severity and prognosis of poisoning. Therefore, we investigated the longitudinal changes of urinary 8-oxoGuo levels during hospitalization in poisoned patients, their association with organ failure, and their predictive value for 30-day readmission risk. In total, 43 poisoning patients were enrolled from the EICU of the First Affiliated Hospital of Wenzhou Medical University between July 2021 and November 2022. The 30-day readmission rate was 18.6%. Group-based trajectory modeling (GBTM) was used to explore the potential trajectories of urinary OS markers and organ failure scores during hospitalization. Spearman’s correlation analysis revealed a significant association between a high trajectory of 8-oxoGuo/creatinine (Cr) and the increased severity of overall organ failure, as well as respiratory and coagulation dysfunctions. Binary logistic regression analysis indicated that a high 8-oxoGuo/Cr trajectory, high respiratory failure score trajectory, and 8-oxoGuo/Cr values at three key points in disease progression (including admission, transfer from EICU, and discharge), along with 8-oxodGuo/Cr levels at admission, were all risk factors for 30-day readmission. The 8-oxoGuo/Cr value at discharge exhibited the best predictive performance. The urinary 8-oxoGuo/Cr ratio may serve as a potential biomarker for prognostic evaluations in patients with poisoning. Levels of urinary oxidative stress indicators remain stable in critically ill poisoned patients during hospitalization.Indicators of urinary oxidative stress correlated with overall, respiratory, coagulation dysfunction severity in critically ill poisoned patients.A high urinary 8-oxoGuo/Cr trajectory was identified as a risk factor for 30-day readmission for poisoned patients in the EICU.The urinary 8-oxoGuo/Cr value at discharge was the best predictor for 30-day readmission in critically ill poisoned patients.The urinary 8-oxoGuo/Cr ratio may serve as a potential prognostic biomarker for critically ill poisoned patients. Levels of urinary oxidative stress indicators remain stable in critically ill poisoned patients during hospitalization. Indicators of urinary oxidative stress correlated with overall, respiratory, coagulation dysfunction severity in critically ill poisoned patients. A high urinary 8-oxoGuo/Cr trajectory was identified as a risk factor for 30-day readmission for poisoned patients in the EICU. The urinary 8-oxoGuo/Cr value at discharge was the best predictor for 30-day readmission in critically ill poisoned patients. The urinary 8-oxoGuo/Cr ratio may serve as a potential prognostic biomarker for critically ill poisoned patients.