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.
METHODS: 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.
METHODS: 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.
RESULTS: 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.
OBJECTIVE: To identify factors associated with seven-day and thirty-day mortality in digoxin poisoning.
METHODS: 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.
METHODS: 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.
RESULTS: 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.
摘要：
背景：地高辛中毒相对常见，可能致命，需要立即进行治疗干预，特别注意患者的血液动力学状态以及心电图和电解质紊乱的存在。
目的：确定与地高辛中毒患者7天和30天死亡率相关的因素。
方法：回顾性研究，观察,在西班牙的15个医院急诊科（HED）进行了多中心研究。包括2015年至2021年参加HED的所有18岁以上的患者。纳入标准包括符合地高辛中毒标准的个人，无论是急性还是慢性。
方法：为了确定与7天和30天死亡率相关的独立因素，进行了多变量分析。这项分析包括临床意义的变量，以及在双变量分析中表现出趋势(p<0.1)或显著性的那些。
结果：共确诊地高辛中毒658例。第7天死亡率为4.5%(30例)，第30天死亡率为11.1%(73例)。关于7天死亡率，死亡患者的平均年龄与幸存者相当(84.7(8.9)岁和83.9(7.9)岁;p=ns).多变量分析显示，与7天死亡率独立相关的因素包括Barthel指数评估的依赖性程度（BI60-89OR0.28;95％CI0.10-0.77;p=0.014和BI>90OR0.22;95％CI0.08-0.63;p=0.005），室性心律失常的鉴定（OR1.34；95％CI1.34-25.21；p=0.019），和存在循环（OR2.84；95％CI1.19-6.27；p=0.019）和神经系统表现（OR2.67；95％CI1.13-6.27；p=0.025）。与30天死亡率独立相关的因素包括依赖性程度（BI60-89OR0.37；95％CI0.20-0.71；p=0.003和BI>90OR0.18；95％CI0.09-0.39；p<0.001）以及循环（OR2.13；95％CI1.10-4.15；p=0.025）和神经系统表现（OR2.39；95％CI1.25-3.89；p=0.006）。
结论：该研究确定了通过Barthel指数评估的依赖程度以及心血管和神经系统症状的存在作为7天和30天死亡率的独立预测因子。此外,室性心律失常的检测也是7日死亡率的独立因素.
目的：确定与地高辛中毒患者7天和30天死亡率相关的因素。
方法：回顾性研究，观察,在西班牙的15个医院急诊科（HED）进行了多中心研究。包括2015年至2021年参加HED的所有18岁以上的患者。纳入标准包括符合地高辛中毒标准的个人，无论是急性还是慢性。
方法：为了确定与7天和30天死亡率相关的独立因素，进行了多变量分析。这项分析包括临床意义的变量，以及在双变量分析中表现出趋势(p<0.1)或显著性的那些。
结果：共确诊地高辛中毒658例。第7天死亡率为4.5%(30例)，第30天死亡率为11.1%(73例)。关于7天死亡率，死亡患者的平均年龄与幸存者相当(84.7(8.9)岁和83.9(7.9)岁;p=ns).多变量分析显示，与7天死亡率独立相关的因素包括Barthel指数评估的依赖性程度（BI60-89OR0.28;95％CI0.10-0.77;p=0.014和BI>90OR0.22;95％CI0.08-0.63;p=0.005），室性心律失常的鉴定（OR1.34；95％CI1.34-25.21；p=0.019），和存在循环（OR2.84；95％CI1.19-6.27；p=0.019）和神经系统表现（OR2.67；95％CI1.13-6.27；p=0.025）。与30天死亡率独立相关的因素包括依赖性程度（BI60-89OR0.37；95％CI0.20-0.71；p=0.003和BI>90OR0.18；95％CI0.09-0.39；p<0.001）以及循环（OR2.13；95％CI1.10-4.15；p=0.025）和神经系统表现（OR2.39；95％CI1.25-3.89；p=0.006）。
结论：该研究确定了通过Barthel指数评估的依赖程度以及心血管和神经系统症状的存在作为7天和30天死亡率的独立预测因子。此外,室性心律失常的检测也是7日死亡率的独立因素.
