Factors associated with prolonged intensive care stay among self-poisoned patients

Figures & data

Figure 1. Flow chart.

Table 1. Comparisons between self-poisoned patients with ICU stay of more and less than seven days.

	Patients with < 7 day-ICU stay (n = 239)	Patients with ≥ 7 day-ICU stay (n = 239)	p Value
Demographic parameters
Age (years)	43 [31–52]	51 [38–65]	<.001
Gender F/M, n (%)	129/110 (54/46)	125/114 (52/48)	.7
Past history, n (%)
Psychiatric diseases	144 (60)	169 (71)	.02
Suicide attempt	94 (39)	94 (39)	1
Addiction	86 (36)	65 (27)	.04
Clinical parameters on admission
Glasgow coma score	14 [8–15]	8 [3–14]	<.001
Temperature (°C)	36.6 [36–37]	36.4 [35.5–37]	.08
Mean arterial pressure (mmHg)	89 [78.5–103]	83 [63–95]	<.001
Heart rate (/min)	89 [73–103]	85 [64–106]	.2
Respiratory frequency (/min)	16 [14–20]	19 [14–24]	<.001
SAPS II	25 [14–43]	56 [43–69]	<.001
Blood lactate (mmol/L)	1.7 [1–3]	2.6 [1.4–5.4]	<.001
Toxicants, n (%)
Psychotropic drugs, including	144 (48)	141 (59)	.01
- Benzodiazepines	74 (31)	83 (34)	.4
- Antidepressants	34 (14)	64 (27)	<.001
Cardiotoxicants	47 (20)	74 (31)	.005
Opioid analgesics and maintenance therapies	41 (17)	34 (14)	.4
Street drugs	41 (17)	32 (13)	.3
Ethanol	67 (28)	14 (6)	<.001
Chemicals	8 (3)	11 (5)	.5
Multidrug exposure	99 (41)	134 (56)	.001
Complications, n (%)
Aspiration pneumonia	54 (23)	201 (84)	<.001
Ventilator-associated pneumonia	0 (0)	78 (33)	<.001
Catheter infection	0 (0)	7 (3)	.02
Urinary infection	4 (2)	26 (11)	<.001
ARDS	0 (0)	47 (20)	<.001
Deep vein thrombosis	0 (0)	14 (7)	<.001
Pulmonary embolism	0 (0)	13 (5)	<.001
Cardiovascular failure^a	35 (15)	144 (60)	<.001
Cardiac contractility impairment^b	22 (9)	77 (32)	<.001
Cardiac arrest	13 (5)	37 (15)	<.001
Seizures	9 (4)	30 (13)	<.001
Status epilepticus	1 (0.4)	10 (4)	.006
Critical illness myopathy and polyneuropathy	0 (0)	17 (7)	<.001
Acute kidney injury	23 (10)	136 (57)	<.001
Acute liver failure	13 (5)	52 (22)	<.001
Thrombocytopenia	17 (7)	12 (5)	.3
Multiple organ failure	29 (12)	181 (76)	<.001
Management
Activated charcoal, n (%)	47 (20)	68 (28)	.03
Antidote, n (%)	95 (40)	133 (56)	<.001
Mechanical ventilation, n (%)	79 (33)	198 (83)	<.001
= > Duration (days)	1 [1–2]	7 [4–10]	<.001
Sedation, n (%)	66 (28)	189 (79)	<.001
= > Duration (days)	1 [1–2]	3 [1–6]	<.001
Catecholamine infusion, n (%)^c	38 (16)	149 (62)	<.001
= > Duration (days)	1 [1–2]	2 [1–4]	<.001
Renal replacement therapy, n (%)	6 (3)	49 (21)	<.001
Albumin dialysis, n (%)	0 (0)	11 (5)	<.001
Veno-arterial ECMO, n (%)	9 (4)	37 (15)	<.001
Outcome
Length of ICU stay (days)	1 [1–2]	12 [8–18]	<.001
Delayed awakening, n (%)	3 (1)	64 (27)	<.001
Death, n (%)	13 (5)	22 (9)	.1

Qualitative variables are expressed as numbers (%) and continuous variables as median [25th-75th percentiles]. p Values <.05 are in bold. ARDS: acute respiratory distress syndrome; ECMO: extracorporeal membrane oxygenation; ICU: Intensive Care Unit; SAPS II: Simple Acute Physiology Score II.

^aRequiring massive fluids or vasopressors.

^bAs evidenced using echocardiography at the bedside.

^cCatecholamines included vasopressor and inotropic drugs administered for shock unresponsive to fluid resuscitation but also as antidotes (such as beta-adrenergic drugs to reverse beta-blocker toxicity).

Figure 2. Drugs involved in self-poisoned patients with prolonged ICU stay of ≥7 days (n = 23) and shorter ICU stay of <7 days (n = 23). ACEI, angiotensin-converting-enzyme inhibitor; ARB, angiotensin II receptor blocker; GHB, gamma-hydroxybutyrate; SSRI, selective serotonin reuptake inhibitors; NSAID, non-steroidal anti-inflammatory drug. Street drugs included the followings: cocaine, amphetamines, GHB, heroin, ketamine, synthetic cathinones, poppers, and cannabis.

Table 2. Characteristics of 239 self-poisoned patients with prolonged ICU stay of more than seven days.

	All patients (n = 239)	Survivors (n = 217)	Deceased (n = 22)	p Value
Demographic parameters
Age (years)	51 [38–65]	53 [39–65]	49 [39–57]	.2
Gender F/M, n (%)	125/114 (52/48)	113/104 (52/48)	12/10 (55/45)	.8
Past history, n (%)
Psychiatric diseases	169 (71)	154 (71)	15 (68)	.8
Suicide attempt	94 (39)	86 (40)	8 (36)	.8
Addiction	65 (27)	55 (25)	10 (45)	.04
Clinical parameters on admission
Glasgow coma score	8 [3–14]	8 [3–14]	4.5 [3–12.8]	.07
Temperature (°C)	36.4 [35.5–37.0]	36.4 [35.5–37.0]	36.0 [35.2–37.4]	.8
Mean arterial pressure (mmHg)	83 [63–95]	83 [62–95]	83 [70–87]	.9
Heart rate (/min)	85 [64–106]	83 [62–104]	104 [75–125]	.04
Respiratory frequency (/min)	19 [14–24]	18 [14–22]	24 [18–30]	.1
SAPS II	56 [43–69]	55 [43–69]	63 [52–73]	.09
Blood lactate (mmol/L)	2.6 [1.4–5.4]	2.5 [1.4–5.4]	3.2 [2.4–9.5]	.06
Toxicants, n (%)
Psychotropic drugs, including	141 (59)	136 (63)	5 (23)	<.001
- Benzodiazepines	83 (34)	80 (37)	3 (14)	.03
- Antidepressants	64 (27)	61 (28)	3 (14)	.1
Cardiotoxicants	74 (31)	68 (31)	6 (27)	.7
Opioid analgesics and maintenance therapies	34 (14)	28 (13)	6 (27)	.1
Street drugs	32 (13)	24 (11)	8 (36)	.004
Ethanol	14 (6)	12 (5.5)	2 (9)	.6
Chemicals	11 (5)	10 (5)	1 (4.5)	1
Multidrug exposure	134 (56)	125 (58)	9 (41)	.1
Complications, n (%)
Aspiration pneumonia	201 (84)	180 (83)	21 (95)	.2
Ventilator-associated pneumonia	78 (33)	69 (32)	9 (41)	.4
Catheter infection	7 (3)	7 (3)	0	1
Urinary infection	26 (11)	24 (11)	2 (9)	1
ARDS	47 (20)	37 (17)	10 (45)	.003
Deep vein thrombosis	14 (7)	14 (6)	0	.4
Pulmonary embolism	13 (5)	13 (6)	0	.6
Cardiovascular failure^a	144 (60)	125 (58)	19 (86)	.01
Cardiac contractility impairment^b	77 (32)	67 (31)	10 (45)	.2
Cardiac arrest	37 (15)	21 (10)	16 (73)	<.001
Seizures	30 (13)	23 (11)	7 (32)	.01
Status epilepticus	10 (4)	6 (3)	4 (18)	.001
Critical illness myopathy and polyneuropathy	17 (7)	17 (8)	0	.4
Acute kidney injury	136 (57)	119 (55)	17 (77)	.04
Acute liver failure	52 (22)	43 (20)	9 (41)	.03
Thrombocytopenia	12 (5)	9 (4)	3 (14)	.09
Multiple organ failure	181 (76)	160 (74)	21 (95)	.02
Management
Activated charcoal, n (%)	68 (28)	64 (29)	4 (18)	.3
Antidote, n (%)	133 (56)	122 (56)	11 (50)	.6
Mechanical ventilation, n (%)	198 (83)	176 (81)	22 (100)	.02
= > Duration (days)	7 [4–10]	6 [3–9]	11 [8–15]	<.001
Sedation, n (%)	189 (79)	170 (78)	19 (86)	.6
= > Duration (days)	3 [1–6]	3 [1–6]	2.5 [1–5]	.7
Catecholamine infusion, n (%)^c	149 (62)	129 (59)	20 (91)	.003
= > Duration (days)	2 [1–4]	2 [1–4]	1 [1–7]	.5
Renal replacement therapy, n (%)	49 (21)	43 (20)	6 (27)	.4
Albumin dialysis, n (%)	11 (4.6)	9 (4)	2 (9)	.3
Veno-arterial ECMO, n (%)	37 (15)	30 (14)	7 (32)	.06
Outcome
Length of ICU stay (days)	12 [8–18]	12 [8–18]	11 [9–15]	.6
Delayed awakening, n (%)	64 (27)	47 (22)	17 (77)^d	<.001

Qualitative variables are expressed as numbers (%) and continuous variables as median [25th-75th percentiles]. p Values <.05 are in bold. ARDS: acute respiratory distress syndrome; ECMO: extracorporeal membrane oxygenation; ICU: Intensive Care Unit; SAPS II: Simple Acute Physiology Score II.

^aRequiring massive fluids or vasopressors.

^bAs evidenced using echocardiography at the bedside.

^cCatecholamines included vasopressor and inotropic drugs administered for shock unresponsive to fluid resuscitation but also as antidotes (such as beta-adrenergic drugs to reverse beta-blocker toxicity).

^dOnly determined in patients who were not sedated or died after sedative drug cessation.

Table 3. Risk factors for prolonged ICU stay in self-poisoned patients based on a multivariate analysis.

Selected parameters	Odds ratio	p Value
Demographics and history
Age	1.02 (0.99; 1.04)	0.1
Psychiatric diseases	0.78 (0.38; 1.59)	0.5
Addiction	0.62 (0.31; 1.26)	0.2
Toxicants
Psychotropic drugs	1.18 (0.53; 2.62)	0.7
Cardiotoxicants	0.68 (0.26; 1.73)	0.4
Ethanol	0.28 (0.11; 0.66)	0.005
Multidrug exposure	1.13 (0.52; 2.45)	0.8
Clinical parameters on admission
SAPS II	1.01 (0.99; 1.03)	0.3
Glasgow coma score	0.98 (0.89; 1.06)	0.6
Complications
Aspiration pneumonia	8.48 (4.28; 17.3)	<0.001
Cardiovascular failure^a	1.33 (0.51; 3.43)	0.6
Cardiac contractility impairment^b	0.64 (0.23; 1.76)	0.4
Cardiac arrest	0.15 (0.04; 0.52)	0.003
Seizures	2.49 (0.77; 8.73)	0.1
Acute kidney injury	3.15 (1.36; 7.39)	0.008
Acute liver failure	0.69 (0.25; 1.99)	0.5
Rhabdomyolysis	0.97 (0.44; 2.12)	0.9
Multiple organ failure	8.06 (3.43; 19.9)	<0.001
Outcome
Delayed awakening^c	8.64 (2.58; 40.7)	0.002
Management
Veno-arterial ECMO	0.82 (0.23; 3.13)	0.8

p Values <.05 are in bold. ECMO: extracorporeal membrane oxygenation; ICU: Intensive Care Unit; SAPS II: Simple Acute Physiology Score II.

^aRequiring massive fluids or vasopressors.

^bAs evidenced using echocardiography at the bedside.

^cFor deceased patents, only determined if not sedated or if death occurred after sedative drug cessation.

Data availability statement

Prof. Mégarbane have full access to all data and takes responsibility for the data integrity and its analysis accuracy.