Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Original research Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis Wenwen Li, Ran Yin, Mengxuan Li, Yili Jin, Wenbin Chen, Yahui Tang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1960167/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Acute poisoning is a worldwide and frequently occurring disease, endangering millions of people and leading to ten thousands of deaths every year. Early effective evaluation and appropriate treatment are the key to improve the clinical outcomes. However, early accurate assessment of the conditions in patients with acute poisoning is challenging. This study aimed to investigate the utility of electrocardiogram (ECG) combined with quick Sequential Organ Failure Assessment (q-SOFA) score as early prognostic predictors in acute poisoning patients. Methods: The clinical data of acute poisoning patients were collected from 2016 to 2022 in a regional medical center. The statistical analysis was used to evaluate the risk factors related to prognosis based on their ECG. And the receiver operating characteristic (ROC) curve were used to evaluate the early diagnostic value of ECG combined with q-SOFA. Results: Among the 572 patients, 119 patients belonged to the survived group and 453 patients belonged to the died. ECG abnormalities were detected in 71.3% of survivors and 88.2% of dead (p＜0.05). One variable analysis revealed that heart rate (HR), ECG axis, PR intervals, RV5, R+S, and ST-T change (all p＜0.05) of ECG had significant differences in the prognosis of patients between two groups. Multifactorial logistic results showed that HR (OR=1.035, 95%CI 1.026~1.044) and QTc (OR=1.013, 95%CI 1.007~1.019) were independent risk factors for death. ROC curve analysis revealed that the area under the cure (AUC) of ECG was 0.777 (95%CI 0.728~0.827), q-SOFA score was 0.736 (95%CI 0.684~0.787), PSS score was 0.617 (95%CI 0.558~0.677), and the prediction model constructed based on HR, QTc and q-SOFA score was 0.808 (95%CI 0.763~0.852), with the best diagnostic accuracy (50.4%). Conclusion: ECG combined with q-SOFA is a useful early predictor of poor outcome in acute poisoning patients. It has better accuracy and certain feasibility compared with PSS score. acute poisoning ECG q-SOFA score PSS score prognosis Figures Figure 1 Background Acute poisoning, occurred with rapid onset and quick deterioration, is one of the common emergencies leading to multiple organ dysfunction and death. According to the World Health Organization (WHO), 84000 people worldwide died from unintentional poisoning in 2019, which was equivalent to 1.1 people per 100000 population[ 1 ]. At the same time, there were more people at risk of poisoning from exposing to toxic substances. The 2020 annual report of the American Association of Poison Control Centers (AAPCC) showed over 3.31 million people exposed to toxic substances in the United States[ 2 ]. In recent years, acute poisoning has become a common cause of hospitalization and death in China. And it is characterized by high incidence, various types of toxicants, obvious regional differences, seasonal changes and younger trend. In addition, it remains a great challenge for emergency physicians to evaluate and treat patients with acute poisoning because of the continuous emergence of new toxicants and the frequent occurrence of mass poisoning events. At present, there is still a lack of universally effective methods for assessing the severity of acute poisoning, especially in the emergency reception sessions with problems that exposure to toxic substances may not be clear and information on various auxiliary tests is very limited. It is a difficult problem for emergency medicine physicians to assess the condition quickly and accurately at the first time. Over the years, the Poisoning Severity Score (PSS), which is based on the grading score of symptoms of each system, has been widely used in assessing the condition of poisoning patients[ 3 , 4 ], and has a predictive ability for the prognosis of poisoning events[ 5 ]. However, several limitations make many experts question the value of PSS score in the assessment of acute poisoning conditions, including that the scoring system has many items and is based mainly on patients' subjective feelings, the objectivity of scoring results is insufficient, and the predictive specificity of the results is low. In addition, some studies found that the Simplified Acute Physiology Score II (SAPS-II), Acute Physiology and Chronic Health Evaluation Score (APACHE) and the Glasgow Coma Scale (GCS) were also valuable in the prognostic diagnosis of acute poisoning patients[ 6 , 7 ].However, these scores often require blood test results and are difficult to apply to the assessment of acute poisoning conditions in the prehospital or at the time of initial admission. Therefore, at this stage, there is still a lack of generally accepted methods for the assessment of poisoning conditions. Quick Sequential Organ Failure Assessment(q-SOFA) is well known as a primary screening method used to patients with suspected sepsis[ 6 , 8 , 9 ], and it is closely associated with organ impairment. Several reports found the significance of q-SOFA score in predicting the prognosis of herbicide poisoning patients[ 10 , 11 ]. Electrocardiogram (ECG) is one of the most readily and rapidly available test for emergency patients, and its value in the evaluation of paraquat poisoning has attracted much attention in recent years[ 12 , 13 ]. However, the evaluation value of ECG and q-SOFA score in the overall population of acute poisoning is not clear. This study retrospectively collected the clinical data of acute poisoning patients in a single center, analyzed the characteristics of ECG changes, the predictive value of q-SOFA score on the prognosis of acute poisoning patients, and the predictive value of the combination of the two on the prognosis of acute poisoning patients. Methods Study Setting and Population A total of 572 patients who were diagnosed with acute poisoning in The First Affiliated Hospital of Wenzhou Medical University between January 2016 and February 2022 were included in this retrospective analysis. Inclusion criteria were: (1) a clear contacted or administration history of poisoning, (2) the performance conformed to the diagnostic criteria of poisoning, (3) 12-lead ECG was detected within 24 hours after hospital admissions. Exclusion criteria were: (1) 12-lead ECG was not tested within 24 hours of admission, (2) history of heart disease, (3) patients with serious basic diseases, (4) patients with severe infectious diseases. Study Protocol and Measures The acute poisoning patients were divided into death group and survival group according to their prognosis, which were assessed according to vital signs. The data of two groups were collected according to clinical records, and including the following: (1) baseline data such as age, gender, basic disease, and occupation, etc. (2) poisoning data such as the type of poisoning, (3) the first obtained values of q-SOFA score and PSS score within the 24 hours after admission, (4) ECG indicators including the rhythm and waveform information. Data Analysis All analyses were conducted using SPSS software (version 22.0, IBM SPSS, USA). The measurement data were tested for normality first. Normal distribution was expressed as mean ± standard deviation (x ± s), and were evaluated by the independent sample t-test. Otherwise, the data were expressed as median (M) and interquartile range (25th -75th percentiles), and were evaluated by the Mann-Whitney U test or Wilcoxon rank-sum test. Categorical variables were expressed as frequency and percentage, and were analyzed by Pearsonχ² test or Fisher exact test. The receiver operating characteristic (ROC) curves and the area under curve (AUC) were used to assess the utility of ECG, q-SOFA, PSS score and ECG combined with q-SOFA prediction model for acute poisoning patients. The level of statistically significant was set at p<0.05. Results Patient Characteristics Among the 572 patients with a clear history of acute poisoning were enrolled in this study for further analysis. The patients were divided into two groups, including death group (n = 119) and survival group (n = 453). The general characteristics data of patients in the two sub-groups are shown in Table 1 . There was no statistically significant differences in age, gender, basic disease and occupation(all P>0.05) between two groups. And there was a statistically significant difference in ECG changes(P<0.05), including abnormal rhythm(P<0.05) and abnormal waveform(P<0.05). Meanwhile, there was also a significant difference in PSS score and q-SOFA score (all P<0.05). Table 1 General characteristics of acute poisoned patients. Death group(n = 119) Survival group(n = 453) χ²/Z P value Age a (years) 52.00(37.00,70.00) 50.50(35.00,65.00) 1.207 0.227 Gender (%) 3.616 0.057 male 67.2(80/119) 57.6(261/453) female 32.8(39/119) 42.4(192/453) Basic disease (%) Hypertension 25.2(30/119) 24.3(110/453) 0.044 0.834 Diabetes 10.1(12/119) 10.4(47/453) 0.009 0.926 Tumors 3.4(4/119) 3.1(14/453) 0.000 1.000 Other 42.0(50/119) 42.4(192/453) 0.005 0.942 Occupation (%) Worker 22.6(27/119) 21.6(98/453) 0.061 0.804 Farmer 33.6(40/119) 29.8(135/453) 0.645 0.422 Student 1.7(2/119) 4.6(21/453) 1.435 0.231 Businessman 4.2(5/119) 6.6(30/453) 0.890 0.345 Staff 2.5(3/119) 5.7(26/453) 1.415 0.234 Unemployed 26.1(31/119) 19.4(88/453) 2.510 0.113 Other 9.2(11/119) 12.1(55/453) 0.775 0.379 Toxic substance (%) Pesticide poisoning 84.0(100/119) 42.6(193/453) 64.740 0.000 Drugs poisoning 7.6(9/119) 30.7(139/453) 26.269 0.000 Compound poisoning 4.2(5/119) 6.2(28/453) 0.679 0.410 Natural poisoning 1.7(2/119) 11.5(52/453) 9.468 0.002 Metal poisoning 0(0/119) 2.2(10/453) 0.132 Gas poisoning 0(0/119) 4.2(19/453) 0.019 Other 2.5(3/119) 2.6(12/453) 0.000 1.000 Abnormal ECG changes (%) Abnormal ECG 88.2(105/119) 71.3(323/453) 14.345 0.000 Abnormal rhythm 58.0(69/119) 28.0(127/453) 37.526 0.000 Abnormal waveform 78.2(93/119) 62.3(282/453) 10.552 0.001 PSS score 2.00(2.00,3.00) 1.00(1.00,2.00) 4.158 0.000 q-SOFA score ≥ 2(%) 36.1(43/119) 10.6(48/453) 45.946 0.000 Age a : date presented as medina (25th, 75th ); PSS score: the Poisoning Severity Score; q-SOFA score: Quick Sequential Organ Failure Assessment. Comparison of ECG Rhythm Changes Between Survival Group and Death Group of Acute Poisoning Patients Table 2 showed that there was a statistically significant difference in ECG rhythm changes between survival group and death group. The main recorded that heart rate (HR) change, sinus tachycardia, sinus bradycardia, and atrial fibrillation had statistical difference (all p<0.05). Table 2 ECG rhythm changes between survival group and death group of acute poisoning patients Death group(n = 119) Survival group(n = 452) χ²/Z P value Heart rate a 109.00(83.00,133.00) 80.00(69.00,93.00) 8.504 0.000 Sinus tachycardia (%) 46.2(55/119) 17.0(77/453) 45.331 0.000 Sinus bradycardia (%) 0.8(1/119) 6.2(28/453) 4.531 0.033 Sinus arrhythmia (%) 0.8(1/119) 4.0(18/453) 1.998 0.159 Escape rhythm (%) 1.7(2/119) 1.5(7/453) 0.000 1.000 Atrial premature beat (%) 5.0(6/119) 2.4(11/453) 2.233 0.135 Atrial fibrillation (%) 5.9(7/119) 0.9(4/453) 9.979 0.002 Ventricular premature beat (%) 2.5(3/119) 1.8(8/453) 0.025 0.874 Heart block (%) 10.9(13/119) 9.1(41/453) 0.387 0.534 Heart rate a : date presented as medina (25th, 75th ); ECG: electrocardiogram. Comparison of ECG Waveform Changes Between Survival Group and Death Group of Acute Poisoning Patients Table 3 showed that the QTc of the death group was significantly longer than that of the survival group (p<0.05), which showed a QT interval prolongation (p<0.05). And there was also a significant difference between two groups in ECG axis, PR intervals, RV5, R + S, and ST-T change (all p<0.05). In addition, the probability of ST-T change of the death group was higher than that of the survival group (p<0.05). Table 3 ECG waveform changes between survival group and death group of acute poisoning patients Death group(n = 119) Survival group(n = 452) χ²/Z P value ECG axis(°) 61.00(25.25,75.00) 53.00(23.00,70.00) 2.418 0.016 QRS interval(ms) 90.50(84.00,96.00) 90.00(86.00,95.50) -0.283 0.777 QT interval(ms) 353.00(300.00,389.25) 378.00(353.00,404.50) -4.691 0.000 QTc(ms) 448.00(428.00,474.75) 433.00(418.00,451.50) 5.289 0.000 PR intervals(ms) 142.50 ± 28.07 152.00(137.00,165.50) -3.016 0.003 SV1(mV) 0.875(0.503,1.223) 0.830(0.570,1.100) 0.164 0.870 RV5(mV) 1.345(0.985,1.820) 1.490(1.130,1.960) -2.149 0.032 S + R(mV) 2.140(1.700,2.830) 2.305(1.900,3.015) -2.065 0.039 QT interval prolongation (%) 45.4(54/119) 23.6(107/453) 22.060 0.000 ST-T change (%) 26.9(32/119) 10.4(47/453) 21.595 0.000 T wave change (%) 19.3(23/119) 22.5(102/453) 0.561 0.454 U wave change (%) 1.7(2/119) 1.8(8/453) 0.000 1.000 Left ventricular high voltage (%) 7.6(9/119) 10.6(48/453) 0.966 0.326 PtfV≤-0.03mm.s (%) 8.4(10/119) 6.6(30/453) 0.460 0.498 Date presented as medina (25th, 75th ) or mean ± SD or n (%); ECG: electrocardiogram. Multifactorial Logistic Regression Analysis of Death in Acute Poisoning Patients The variables (HR, ECG axis, QTc, PR intervals, RV5, R + S) that were significant in the univariate logistic regression analysis were selected for multivariate analysis. Multivariate logistic regression analysis confirmed that HR (OR = 1.035, 95%CI 1.026 ~ 1.044) and QTc (OR = 1.013, 95%CI 1.007 ~ 1.019) were independent risk factors for prognosis of acute poisoning patients, and the data were showed in Table 4 . The ECG prediction model was constructed by HR and QTc, and the ECG combined with qSOFA prediction model was constructed by HR, QTc and qSOFA. Table 4 Multifactorial logistic regression analysis Variable β S.E. Wald P value OR 95%CI HR 0.039 0.005 58.906 0.000 1.040 1.029 ~ 1.050 QTc 0.013 0.003 15.203 0.000 1.013 1.006 ~ 1.019 ECG axis 0.000 0.003 0.015 0.902 1.000 0.993 ~ 1.006 PR intervals 0.000 0.002 0.026 0.871 1.000 0.996 ~ 1.005 RV5 0.352 0.334 1.112 0.292 1.422 0.739 ~ 2.735 RS -0.240 0.250 0.922 0.337 0.787 0.482 ~ 1.284 ECG: electrocardiogram; HR: heart rate; OR: odds ratio; CI: confidence interval Table 5 ROC curve analysis. Variable AUC 95%CI Cutoff Sensitivity (%) Specificity (%) Youden index (%) ECG 0.777 0.728 ~ 0.827 0.212 69.7 77.3 47.0 q-SOFA 0.736 0.684 ~ 0.787 0.500 79.8 60.3 40.1 PSS 0.617 0.558 ~ 0.677 2.500 46.2 72.0 18.2 ECG combined with q-SOFA 0.808 0.763 ~ 0.852 0.191 73.1 77.3 50.4 ECG: electrocardiogram; q-SOFA score: Quick Sequential Organ Failure Assessment; PSS score: the Poisoning Severity Score; AUC: the area under the cure; CI: confidence interval ROC Curve Analysis For the Prognosis of Acute Poisoning Patients The ECG combined with q-SOFA prediction model, which constructed by multifactor regression, together with ECG prediction model, q-SOFA score and PSS score to construct ROC curves. The ROC curves showed in Fig. 1 and the data showed in Table 4 . The ECG combined with q-SOFA and PSS score had significant different in the prediction of prognosis in PQ poisoning patients (p<0.05). In conclusion, the ECG combined with q-SOFA model had the best diagnostic value with the largest area under the cure (AUC) and the optimal cut-off value of 0.191. In addition, the highest Youden index was obtained by the ECG combined with q-SOFA model (50.4%). Discussion In the present study, we found that ECG and q-SOFA score have good value in evaluating the condition and prognosis of acute poisoning. It is proposed for the first time that the effect of combined application of ECG and q-SOFA in predicting the outcome of acute poisoning is better than that of PSS score (p<0.05), and has better sensitivity and specificity. As ECG and q-SOFA score can be obtained and completed quickly after emergency admission, the combined application of the two can provide a more objective and accurate method for assessing the condition of acute poisoning, which has the potential value of popularization and application in emergency medicine. Acute poisoning is a systemic disease that can lead to multiple system involvement and even multiple organ dysfunction. As the most important pivotal organ, the cardiac system is easily affected by various states of the whole body, and electrophysiological changes and ECG changes are one of the most sensitive indicators of cardiac effects. It has been reported that electrophysiological changes and ECG changes in acute carbon monoxide poisoning patients appear earlier than the elevation of cardiomyocyte injury markers such as CK-MB and TNI[ 14 ]. The mechanism of acute poisoning leading to ECG changes mainly include: (1) Direct action, the toxic substance can cause ECG changes by interfering with cardiomyocyte metabolism[ 15 ], directly damaging sodium, potassium and calcium ion channels[ 16 ], and destroying blood vessels[ 17 ]. (2) Indirect effects, toxic substances can indirectly affect the cardiovascular system by regulating systemic pathological alterations[ 18 – 20 ]. For example, carbon monoxide altered hemoglobin oxygenation, and leading to ECG changes due to hypoxia in patients[ 21 ]. Moreover, some drugs poisoning could easily lead to systemic electrolyte abnormalities and thus alter ECG[ 22 ]. (3) Arrhythmia is induced by stimulation of sympathetic nerve activity. A report suggested that some organic solvents can affect sympathetic activity and alter ECG[ 23 ]. The present study showed that ECG changes in acute poisoning included rhythm changes (34.3%) and morphological changes (65.6%). The rhythm changes were dominated by HR changes, and morphological changes were most significant by QTc changes. Meanwhile, our study revealed that HR (OR = 1.035, 95%CI 1.026 ~ 1.044) and QTc (OR = 1.013, 95%CI 1.007 ~ 1.019) were the independent risk factors for predicting poor prognosis in poisoned patients. A report confirmed that QTc can be used as a predictor of the adverse outcomes in acute poisoning[ 24 ]. Likewise, another study demonstrated that ECG can be used as an indicator of cardiovascular prognosis in patients with acute drug poisoning[ 25 ]. These findings were in agreement with our study results, which were applicable to a broader population than the aforementioned studies. Based on a score of consciousness, systolic blood pressure, and respiratory rate, the q-SOFA score is commonly used to screen suspected sepsis patients as recommended by the Third International Sepsis Consensus Definitions Task Force[ 26 – 28 ]. Williams JM et al. found that the q-SOFA score can be used to screen infected patients for organ dysfunction and risk of death with a high degree of specificity[ 29 ]. Meanwhile, Cho YS et al. found that the q-SOFA score is an accurate predictor of poor outcome due to organ damage in glyphosate herbicide poisoning[ 10 , 11 ]. Our data suggested that the q-SOFA score has moderate value in predicting the prognosis of poisoned patients (AUC 0.736,95%CI 0.684 ~ 0.787). Compared to ECG indicators (AUC 0.777,95%CI 0.728 ~ 0.827), the q-SOFA score has a high sensitivity, but lower specificity. One study demonstrated that ECG combined with q-SOFA score improved risk stratification for patients with acute pulmonary embolism[ 30 ]. Moreover, several reports indicate that combining heart rate variability with q-SOFA can effectively improve predictive ability for mortality in patients with sepsis[ 31 , 32 ]. These studies indicated that electrophysiological alterations might precede the appearance of cellular damage, ECG could be a useful supplement to the predictive efficiency of q-SOFA. Therefore, we explored the utility of combination of ECG and q-SOFA score for acute poisoning patients. Our study revealed that ECG combined with q-SOFA score (AUC 0.808, 95%CI 0.763 ~ 0.852) had a better predictive value than PSS score (AUC 0.617, 95%CI 0.558 ~ 0.677, p<0.05). In fact, the PSS score is a widely accepted tool for predicting the prognosis for poisoning[ 33 – 35 ]. However, PSS clinical utility is limited by its complexity and subjectivity[ 36 ]. Meanwhile, the score of ECG combined with q-SOFA seems more easy, objective and accuracy, which could be suitable for the acute poisoning patients with less information in stages of pre-hospital or triage in emergency department. Inevitably, our study has some limitations. Firstly, the data was obtained from single-center with its possible selection bias. Secondly, in order to eliminate the interference of previous cardiac diseases on ECG, we excluded patients with previous cardiac injury in this retrospective study. Thus, the results are not suitable for the acute poisoning patients with previous cardiac disease. Conclusions In conclusion, the ability of ECG combined with q-SOFA score to identify poor prognosis of pre-hospital acute poisoning is better that PSS score, meanwhile it has better accuracy and feasibility compared. The combination of ECG and q-SOFA score is promising for widespread clinical application. Abbreviations ECG electrocardiogram q-SOFA Quick Sequential Organ Failure Assessment PSS the Poisoning Severity Score AUC the area under the cure Declarations Ethics approval This retrospective clinical study was implemented according to the 1975 Declaration of Helsinki, and was approved by the Medical Ethics Committee of *** (Register number: 2018-170). Informed consent regarding the treatment risk following poisoning was obtained from all patients upon their initial admission within 24h. All data gathered from clinical patient records was anonymized and securely protected. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by grants from the National Natural Science Foundation of China (81871550), the National Key R&D Program of China (2021YFC3002205) and the Key Specialty of Traditional Chinese Medicine in the 13th Five-Year Plan of Zhejiang Province. Authors ’ contributions GH and SZ conceptualized and designed the study. WL, RY, M L, YJ and WC performed the study and acquired the data. YT and YX analyzed the data. WL and SZ drafted the manuscript. GH and YX revised the paper. GH and SZ contribute equally to this study. All authors read and approved the final manuscript. Acknowledgements We acknowledge the Information Centre staff in our hospital for general support. Author details a Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China. b Wenzhou Key Laboratory of emergency and disaster medicine, Wenzhou 325000, China. References World Health Statistics. 2021: World Health Organization; 2021 [updated https://apps.who.int/iris/bitstream/handle/10665/342703/9789240027053-eng.pdf] . Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282–1501. Conner KR, Wiegand TJ, Gorodetsky R, et al. Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self-poisoning. Behav Sci Law. 2019 May;37(3):240–6. Davies JO, Eddleston M, Buckley NA. Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. QJM. 2008 May;101(5):371–9. El-Sarnagawy GN, Abdelnoor AA, Abuelfadl AA, et al. Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients. Environ Sci Pollut Res Int. 2022 May;29(23):33999–4009. Banderas-Bravo ME, Arias-Verdu MD, Macias-Guarasa I, et al. Patients Admitted to Three Spanish Intensive Care Units for Poisoning: Type of Poisoning, Mortality, and Functioning of Prognostic Scores Commonly Used. Biomed Res Int. 2017;2017:5261264. Farzaneh E, Ghobadi H, Akbarifard M, et al. Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk-Prediction Nomogram Approach. Basic Clin Pharmacol Toxicol. 2018 Sep;123(3):347–55. Freund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017 Jan;17(3):301–8. 317(. Wang C, Xu R, Zeng Y, et al. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS ONE. 2022;17(4):e0266755. Cho YS, Chun BJ, Moon JM. The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning. Basic Clin Pharmacol Toxicol. 2018 Nov;123(5):615–21. Cho YS, Moon JM, Chun BJ, et al. Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department. Shock. 2019 Apr;51(4):447–452. Isiguzo GC, Iroezindu MO, Muoneme AS, et al. Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria. Niger J Clin Pract. 2017 Sep;20(9):1133–8. Mladenka P, Applova L, Patocka J, et al. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev. 2018 Jul;38(4):1332–403. Liu Y, Gao X, Xiao Q, et al. Correlation Between QTc Dispersion and Soluble Growth-stimulating Gene 2 Protein on the Early Prognosis of Acute Carbon Monoxide Poisoning Heart Disease. J Cardiovasc Pharmacol. 2021 Oct 1;78(4):572–580. Dostal V, Wood SD, Thomas CT, et al. Proteomic signatures of acute oxidative stress response to paraquat in the mouse heart. Sci Rep. 2020 Oct;28(1):18440. 10(. Santos Ruybal MCP, Gallego M, Sottani TBB, et al. Methylmercury Poisoning Induces Cardiac Electrical Remodeling and Increases Arrhythmia Susceptibility and Mortality. Int J Mol Sci. 2020 May 15;21(10). Ferreira G, Santander A, Chavarria L, et al. Functional consequences of lead and mercury exposomes in the heart. Mol Aspects Med. 2021 Nov;13:101048. El-Nahhal Y, El-Nahhal I. Cardiotoxicity of some pesticides and their amelioration. Environ Sci Pollut Res Int. 2021 Sep;28(33):44726–54. Robison LB, Brady WJ, Robison RA, et al. QT interval prolongation and the rate of malignant ventricular dysrhythmia and cardiac arrest in adult poisoned patients. Am J Emerg Med. 2021 Aug;46:156–9. Carreiro S, Miller S, Wang B, et al. Clinical predictors of adverse cardiovascular events for acute pediatric drug exposures. Clin Toxicol (Phila). 2020 Mar;58(3):183–9. Longhitano Y, Candelli M, Muir HA, et al. Non-infarctual ST elevation and acute cardiopulmonary failure in carbon monoxide poisoning: a case report. Eur Rev Med Pharmacol Sci. 2019 Aug;23(16):7128–34. Muniz AE. Valproic Acid Overdose Review of a Case With Electrocardiographic Changes. J Emerg Med. 2017 Sep;53(3):333–8. Murata K, Araki S, Yokoyama K, et al. Autonomic and peripheral nervous system dysfunction in workers exposed to mixed organic solvents. Int Arch Occup Environ Health. 1991;63(5):335–40. El-Sarnagawy GN, Shaban AE, Lashin HI. Validation of Corrected and Dispersed QT as Predictors of Adverse Outcomes in Acute Cardiotoxicities. Cardiovasc Toxicol. 2022 Jan;22(1):1–13. Manini AF, Nair AP, Vedanthan R, et al. Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose. J Am Heart Assoc. 2017 Feb 3;6(2). Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):762 – 74. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb;23(8):801–10. 315(. Charitos IA, Topi S, Castellaneta F, et al. Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments. Antibiotics (Basel). 2019 May 7;8(2). Williams JM, Greenslade JH, McKenzie JV, et al. Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection. Chest. 2017 Mar;151(3):586–96. Teng F, Chen YX, He XH, et al. Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism. Chin Med J (Engl). 2018 Oct;20(20):2395–401. 131(. Samsudin MI, Liu N, Prabhakar SM, et al. A novel heart rate variability based risk prediction model for septic patients presenting to the emergency department. Med (Baltim). 2018 Jun;97(23):e10866. Prabhakar SM, Tagami T, Liu N, et al. Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department. PLoS ONE. 2019;14(3):e0213445. Sun Y, Yang Y, Zhang Z, et al. Early enteral nutrition combined with PSS-based nursing in the treatment of organophosphorus pesticide poisoning. Am J Transl Res. 2021;13(8):9315–23. Rietjens SJ, Sikma MA, Hunault CC, et al. Pregabalin poisoning: Evaluation of dose-toxicity relationship. Br J Clin Pharmacol. 2022 Mar;88(3):1288–97. Wang IJ, Yeom SR, Park SW, et al. Poison severity score and sequential organ failure assessment score: Carbon monoxide poisoning prognosis. PLoS ONE. 2019;14(3):e0212025. Schwarz ES, Kopec KT, Wiegand TJ, et al. Should We Be Using the Poisoning Severity Score? J Med Toxicol. 2017 Jun;13(2):135–45. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1960167","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Original research","associatedPublications":[],"authors":[{"id":130862849,"identity":"1218ba9f-bd4f-491c-9e02-b4b5afc86fed","order_by":0,"name":"Wenwen Li","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenwen","middleName":"","lastName":"Li","suffix":""},{"id":130862850,"identity":"672dadb1-c11f-466d-a278-9e37e3753074","order_by":1,"name":"Ran Yin","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ran","middleName":"","lastName":"Yin","suffix":""},{"id":130862851,"identity":"7c3badba-e84b-4f1b-8554-9a89c6d28bdc","order_by":2,"name":"Mengxuan Li","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mengxuan","middleName":"","lastName":"Li","suffix":""},{"id":130862852,"identity":"00dc4e55-9dba-4b66-8e44-b774da5e6113","order_by":3,"name":"Yili Jin","email":"","orcid":"","institution":", Wenzhou Medical University First Affiliated Hospital: The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yili","middleName":"","lastName":"Jin","suffix":""},{"id":130862853,"identity":"8329577b-ad34-4907-bfe3-5cab99e27f98","order_by":4,"name":"Wenbin Chen","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenbin","middleName":"","lastName":"Chen","suffix":""},{"id":130862854,"identity":"70e1edb6-c1e4-449b-bc8b-a62fa1e59149","order_by":5,"name":"Yahui Tang","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yahui","middleName":"","lastName":"Tang","suffix":""},{"id":130862855,"identity":"1f40a0ef-3b3d-47de-8f1f-0baf70c22db1","order_by":6,"name":"Yu Xia","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Xia","suffix":""},{"id":130862856,"identity":"a81aac7d-ae22-4678-9cac-fb38300447e9","order_by":7,"name":"Shaoce Zhi","email":"","orcid":"","institution":", The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shaoce","middleName":"","lastName":"Zhi","suffix":""},{"id":130862857,"identity":"e88d3490-bc22-4c9f-b835-0677726f1851","order_by":8,"name":"Guangliang Hong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACAzBZYCPHz8x88AEJWgzSjCXb2ZINSNFyOHHDeR4zAaK0mLP3Hn75xeCwsfFhBjMGhhqbaIJaLHvOpVnLGKTLmR1mSHvAcCwtt4Ggw27kmBlLGFgbA7UcN2BsOEy0FubEzc2MbRLEajF++MHAOXEDMzMbkVrOnDFjBgWyxGE2ZoMEovxyvMf4448KYFT2n//44EONDWEtQMAmzQNjJhChHASYP/4gUuUoGAWjYBSMUAAAnHM+DXaY8lMAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5822-7705","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Guangliang","middleName":"","lastName":"Hong","suffix":""}],"badges":[],"createdAt":"2022-08-14 03:49:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1960167/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1960167/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":25623542,"identity":"3c747410-47ba-4642-9a69-4491e3b8bfbd","added_by":"auto","created_at":"2022-08-24 17:31:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68892,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curve analysis of ECG prediction model, q-SOFA score, PSS score, and ECG combined with q-SOFA model in the prognosis diagnosis of acute poisoning patients. There was a statistically significant difference between the AUC of the PSS score and the AUC of the ECG combined with q-SOFA (p＜0.05). ECG: electrocardiogram; q-SOFA score: Quick Sequential Organ Failure Assessment; PSS score: the Poisoning Severity Score; AUC: the area under the cure\u003c/p\u003e","description":"","filename":"Onlinefigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1960167/v1/7c8a4911a89ff2d074d0f63e.png"},{"id":27759046,"identity":"55ec59e1-6f1b-443f-a483-50f1d4fa4eb8","added_by":"auto","created_at":"2022-10-14 06:05:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":614790,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1960167/v1/7de6dc52-4188-46e1-9ec4-04aedcddca03.pdf"}],"financialInterests":"","formattedTitle":"Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute poisoning, occurred with rapid onset and quick deterioration, is one of the common emergencies leading to multiple organ dysfunction and death. According to the World Health Organization (WHO), 84000 people worldwide died from unintentional poisoning in 2019, which was equivalent to 1.1 people per 100000 population[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. At the same time, there were more people at risk of poisoning from exposing to toxic substances. The 2020 annual report of the American Association of Poison Control Centers (AAPCC) showed over 3.31\u0026nbsp;million people exposed to toxic substances in the United States[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In recent years, acute poisoning has become a common cause of hospitalization and death in China. And it is characterized by high incidence, various types of toxicants, obvious regional differences, seasonal changes and younger trend. In addition, it remains a great challenge for emergency physicians to evaluate and treat patients with acute poisoning because of the continuous emergence of new toxicants and the frequent occurrence of mass poisoning events.\u003c/p\u003e \u003cp\u003eAt present, there is still a lack of universally effective methods for assessing the severity of acute poisoning, especially in the emergency reception sessions with problems that exposure to toxic substances may not be clear and information on various auxiliary tests is very limited. It is a difficult problem for emergency medicine physicians to assess the condition quickly and accurately at the first time.\u003c/p\u003e \u003cp\u003eOver the years, the Poisoning Severity Score (PSS), which is based on the grading score of symptoms of each system, has been widely used in assessing the condition of poisoning patients[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and has a predictive ability for the prognosis of poisoning events[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, several limitations make many experts question the value of PSS score in the assessment of acute poisoning conditions, including that the scoring system has many items and is based mainly on patients' subjective feelings, the objectivity of scoring results is insufficient, and the predictive specificity of the results is low. In addition, some studies found that the Simplified Acute Physiology Score II (SAPS-II), Acute Physiology and Chronic Health Evaluation Score (APACHE) and the Glasgow Coma Scale (GCS) were also valuable in the prognostic diagnosis of acute poisoning patients[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].However, these scores often require blood test results and are difficult to apply to the assessment of acute poisoning conditions in the prehospital or at the time of initial admission. Therefore, at this stage, there is still a lack of generally accepted methods for the assessment of poisoning conditions.\u003c/p\u003e \u003cp\u003eQuick Sequential Organ Failure Assessment(q-SOFA) is well known as a primary screening method used to patients with suspected sepsis[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and it is closely associated with organ impairment. Several reports found the significance of q-SOFA score in predicting the prognosis of herbicide poisoning patients[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Electrocardiogram (ECG) is one of the most readily and rapidly available test for emergency patients, and its value in the evaluation of paraquat poisoning has attracted much attention in recent years[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, the evaluation value of ECG and q-SOFA score in the overall population of acute poisoning is not clear.\u003c/p\u003e \u003cp\u003eThis study retrospectively collected the clinical data of acute poisoning patients in a single center, analyzed the characteristics of ECG changes, the predictive value of q-SOFA score on the prognosis of acute poisoning patients, and the predictive value of the combination of the two on the prognosis of acute poisoning patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting and Population\u003c/h2\u003e \u003cp\u003eA total of 572 patients who were diagnosed with acute poisoning in The First Affiliated Hospital of Wenzhou Medical University between January 2016 and February 2022 were included in this retrospective analysis. Inclusion criteria were: (1) a clear contacted or administration history of poisoning, (2) the performance conformed to the diagnostic criteria of poisoning, (3) 12-lead ECG was detected within 24 hours after hospital admissions. Exclusion criteria were: (1) 12-lead ECG was not tested within 24 hours of admission, (2) history of heart disease, (3) patients with serious basic diseases, (4) patients with severe infectious diseases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Protocol and Measures\u003c/h2\u003e \u003cp\u003eThe acute poisoning patients were divided into death group and survival group according to their prognosis, which were assessed according to vital signs. The data of two groups were collected according to clinical records, and including the following: (1) baseline data such as age, gender, basic disease, and occupation, etc. (2) poisoning data such as the type of poisoning, (3) the first obtained values of q-SOFA score and PSS score within the 24 hours after admission, (4) ECG indicators including the rhythm and waveform information.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were conducted using SPSS software (version 22.0, IBM SPSS, USA). The measurement data were tested for normality first. Normal distribution was expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and were evaluated by the independent sample t-test. Otherwise, the data were expressed as median (M) and interquartile range (25th -75th percentiles), and were evaluated by the Mann-Whitney U test or Wilcoxon rank-sum test. Categorical variables were expressed as frequency and percentage, and were analyzed by Pearsonχ\u0026sup2; test or Fisher exact test. The receiver operating characteristic (ROC) curves and the area under curve (AUC) were used to assess the utility of ECG, q-SOFA, PSS score and ECG combined with q-SOFA prediction model for acute poisoning patients. The level of statistically significant was set at p\u003c0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003ePatient Characteristics\u003c/h2\u003e\n\u003cp\u003eAmong the 572 patients with a clear history of acute poisoning were enrolled in this study for further analysis. The patients were divided into two groups, including death group (n\u0026thinsp;=\u0026thinsp;119) and survival group (n\u0026thinsp;=\u0026thinsp;453). The general characteristics data of patients in the two sub-groups are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no statistically significant differences in age, gender, basic disease and occupation(all P\u003e0.05) between two groups. And there was a statistically significant difference in ECG changes(P\u0026lt;0.05), including abnormal rhythm(P\u0026lt;0.05) and abnormal waveform(P\u0026lt;0.05). Meanwhile, there was also a significant difference in PSS score and q-SOFA score (all P\u0026lt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGeneral characteristics of acute poisoned patients.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDeath group(n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurvival group(n\u0026thinsp;=\u0026thinsp;453)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;/Z\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge \u003csup\u003ea\u003c/sup\u003e (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.00(37.00,70.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50.50(35.00,65.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.227\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.616\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.057\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67.2(80/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57.6(261/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.8(39/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.4(192/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBasic disease (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.2(30/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.3(110/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.044\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.834\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1(12/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.4(47/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.926\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTumors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.4(4/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.1(14/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.0(50/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.4(192/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.942\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOccupation (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.6(27/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21.6(98/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.061\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.804\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFarmer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.6(40/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29.8(135/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.645\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.422\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.7(2/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.6(21/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.435\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.231\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBusinessman\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.2(5/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.6(30/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.890\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.345\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStaff\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5(3/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.7(26/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.415\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.234\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.1(31/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.4(88/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.113\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.2(11/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.1(55/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.775\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.379\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eToxic substance (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePesticide poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.0(100/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.6(193/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64.740\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDrugs poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.6(9/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30.7(139/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.269\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCompound poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.2(5/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.2(28/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.679\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.410\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNatural poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.7(2/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.5(52/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.468\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMetal poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.2(10/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.132\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGas poisoning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.2(19/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.019\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5(3/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.6(12/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbnormal ECG changes (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbnormal ECG\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88.2(105/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71.3(323/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.345\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbnormal rhythm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.0(69/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.0(127/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37.526\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbnormal waveform\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78.2(93/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62.3(282/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.552\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePSS score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.00(2.00,3.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.00(1.00,2.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eq-SOFA score\u0026thinsp;\u0026ge;\u0026thinsp;2(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.1(43/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.6(48/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.946\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eAge\u003csup\u003ea\u003c/sup\u003e: date presented as medina (25th, 75th ); PSS score: the Poisoning Severity Score; q-SOFA score: Quick Sequential Organ Failure Assessment.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eComparison of ECG Rhythm Changes Between Survival Group and Death Group of Acute Poisoning Patients\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e showed that there was a statistically significant difference in ECG rhythm changes between survival group and death group. The main recorded that heart rate (HR) change, sinus tachycardia, sinus bradycardia, and atrial fibrillation had statistical difference (all p\u0026lt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eECG rhythm changes between survival group and death group of acute poisoning patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDeath group(n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurvival group(n\u0026thinsp;=\u0026thinsp;452)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;/Z\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeart rate\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e109.00(83.00,133.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80.00(69.00,93.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.504\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSinus tachycardia (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46.2(55/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17.0(77/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSinus bradycardia (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.8(1/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.2(28/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.531\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSinus arrhythmia (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.8(1/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.0(18/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.998\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.159\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEscape rhythm (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.7(2/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.5(7/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAtrial premature beat (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.0(6/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.4(11/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.135\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAtrial fibrillation (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.9(7/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.9(4/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.979\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVentricular premature beat (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.5(3/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8(8/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.874\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeart block (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.9(13/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.1(41/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.387\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.534\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eHeart rate\u003csup\u003ea\u003c/sup\u003e: date presented as medina (25th, 75th ); ECG: electrocardiogram.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eComparison of ECG Waveform Changes Between Survival Group and Death Group of Acute Poisoning Patients\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e showed that the QTc of the death group was significantly longer than that of the survival group (p\u0026lt;0.05), which showed a QT interval prolongation (p\u0026lt;0.05). And there was also a significant difference between two groups in ECG axis, PR intervals, RV5, R\u0026thinsp;+\u0026thinsp;S, and ST-T change (all p\u0026lt;0.05). In addition, the probability of ST-T change of the death group was higher than that of the survival group (p\u0026lt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eECG waveform changes between survival group and death group of acute poisoning patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDeath group(n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurvival group(n\u0026thinsp;=\u0026thinsp;452)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;/Z\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECG axis(\u0026deg;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61.00(25.25,75.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53.00(23.00,70.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.418\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQRS interval(ms)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e90.50(84.00,96.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e90.00(86.00,95.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.283\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.777\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQT interval(ms)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e353.00(300.00,389.25)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e378.00(353.00,404.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-4.691\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQTc(ms)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e448.00(428.00,474.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e433.00(418.00,451.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.289\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePR intervals(ms)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e142.50\u0026thinsp;\u0026plusmn;\u0026thinsp;28.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e152.00(137.00,165.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-3.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSV1(mV)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.875(0.503,1.223)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.830(0.570,1.100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.870\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRV5(mV)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.345(0.985,1.820)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.490(1.130,1.960)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-2.149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eS\u0026thinsp;+\u0026thinsp;R(mV)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.140(1.700,2.830)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.305(1.900,3.015)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-2.065\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQT interval prolongation (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.4(54/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23.6(107/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eST-T change (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.9(32/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.4(47/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21.595\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eT wave change (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.3(23/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22.5(102/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.561\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.454\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eU wave change (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.7(2/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8(8/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft ventricular high voltage (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.6(9/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.6(48/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.966\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.326\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePtfV\u0026le;-0.03mm.s (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.4(10/119)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.6(30/453)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.460\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.498\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eDate presented as medina (25th, 75th ) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%); ECG: electrocardiogram.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eMultifactorial Logistic Regression Analysis of Death in Acute Poisoning Patients\u003c/h2\u003e\n\u003cp\u003eThe variables (HR, ECG axis, QTc, PR intervals, RV5, R\u0026thinsp;+\u0026thinsp;S) that were significant in the univariate logistic regression analysis were selected for multivariate analysis. Multivariate logistic regression analysis confirmed that HR (OR\u0026thinsp;=\u0026thinsp;1.035, 95%CI 1.026\u0026thinsp;~\u0026thinsp;1.044) and QTc (OR\u0026thinsp;=\u0026thinsp;1.013, 95%CI 1.007\u0026thinsp;~\u0026thinsp;1.019) were independent risk factors for prognosis of acute poisoning patients, and the data were showed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. The ECG prediction model was constructed by HR and QTc, and the ECG combined with qSOFA prediction model was constructed by HR, QTc and qSOFA.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultifactorial logistic regression analysis\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eS.E.\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWald\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.906\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.040\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.029\u0026thinsp;~\u0026thinsp;1.050\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQTc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15.203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.006\u0026thinsp;~\u0026thinsp;1.019\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECG axis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.902\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.993\u0026thinsp;~\u0026thinsp;1.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePR intervals\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.026\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.871\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.996\u0026thinsp;~\u0026thinsp;1.005\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRV5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.352\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.334\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.292\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.422\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.739\u0026thinsp;~\u0026thinsp;2.735\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.922\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.337\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.482\u0026thinsp;~\u0026thinsp;1.284\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eECG: electrocardiogram; HR: heart rate; OR: odds ratio; CI: confidence interval\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eROC curve analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAUC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCutoff\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSensitivity (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSpecificity (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYouden index (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECG\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.777\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.728\u0026thinsp;~\u0026thinsp;0.827\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.212\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e77.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eq-SOFA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.736\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.684\u0026thinsp;~\u0026thinsp;0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePSS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.617\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.558\u0026thinsp;~\u0026thinsp;0.677\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECG combined with q-SOFA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.808\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.763\u0026thinsp;~\u0026thinsp;0.852\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.191\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e77.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eECG: electrocardiogram; q-SOFA score: Quick Sequential Organ Failure Assessment; PSS score: the Poisoning Severity Score; AUC: the area under the cure; CI: confidence interval\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eROC Curve Analysis For the Prognosis of Acute Poisoning Patients\u003c/h2\u003e\n\u003cp\u003eThe ECG combined with q-SOFA prediction model, which constructed by multifactor regression, together with ECG prediction model, q-SOFA score and PSS score to construct ROC curves. The ROC curves showed in Fig.\u0026nbsp;1 and the data showed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. The ECG combined with q-SOFA and PSS score had significant different in the prediction of prognosis in PQ poisoning patients (p\u0026lt;0.05). In conclusion, the ECG combined with q-SOFA model had the best diagnostic value with the largest area under the cure (AUC) and the optimal cut-off value of 0.191. In addition, the highest Youden index was obtained by the ECG combined with q-SOFA model (50.4%).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we found that ECG and q-SOFA score have good value in evaluating the condition and prognosis of acute poisoning. It is proposed for the first time that the effect of combined application of ECG and q-SOFA in predicting the outcome of acute poisoning is better than that of PSS score (p\u003c0.05), and has better sensitivity and specificity. As ECG and q-SOFA score can be obtained and completed quickly after emergency admission, the combined application of the two can provide a more objective and accurate method for assessing the condition of acute poisoning, which has the potential value of popularization and application in emergency medicine.\u003c/p\u003e \u003cp\u003eAcute poisoning is a systemic disease that can lead to multiple system involvement and even multiple organ dysfunction. As the most important pivotal organ, the cardiac system is easily affected by various states of the whole body, and electrophysiological changes and ECG changes are one of the most sensitive indicators of cardiac effects. It has been reported that electrophysiological changes and ECG changes in acute carbon monoxide poisoning patients appear earlier than the elevation of cardiomyocyte injury markers such as CK-MB and TNI[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The mechanism of acute poisoning leading to ECG changes mainly include: (1) Direct action, the toxic substance can cause ECG changes by interfering with cardiomyocyte metabolism[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], directly damaging sodium, potassium and calcium ion channels[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and destroying blood vessels[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. (2) Indirect effects, toxic substances can indirectly affect the cardiovascular system by regulating systemic pathological alterations[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For example, carbon monoxide altered hemoglobin oxygenation, and leading to ECG changes due to hypoxia in patients[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, some drugs poisoning could easily lead to systemic electrolyte abnormalities and thus alter ECG[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. (3) Arrhythmia is induced by stimulation of sympathetic nerve activity. A report suggested that some organic solvents can affect sympathetic activity and alter ECG[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The present study showed that ECG changes in acute poisoning included rhythm changes (34.3%) and morphological changes (65.6%). The rhythm changes were dominated by HR changes, and morphological changes were most significant by QTc changes. Meanwhile, our study revealed that HR (OR\u0026thinsp;=\u0026thinsp;1.035, 95%CI 1.026\u0026thinsp;~\u0026thinsp;1.044) and QTc (OR\u0026thinsp;=\u0026thinsp;1.013, 95%CI 1.007\u0026thinsp;~\u0026thinsp;1.019) were the independent risk factors for predicting poor prognosis in poisoned patients. A report confirmed that QTc can be used as a predictor of the adverse outcomes in acute poisoning[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Likewise, another study demonstrated that ECG can be used as an indicator of cardiovascular prognosis in patients with acute drug poisoning[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These findings were in agreement with our study results, which were applicable to a broader population than the aforementioned studies.\u003c/p\u003e \u003cp\u003eBased on a score of consciousness, systolic blood pressure, and respiratory rate, the q-SOFA score is commonly used to screen suspected sepsis patients as recommended by the Third International Sepsis Consensus Definitions Task Force[\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Williams JM et al. found that the q-SOFA score can be used to screen infected patients for organ dysfunction and risk of death with a high degree of specificity[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Meanwhile, Cho YS et al. found that the q-SOFA score is an accurate predictor of poor outcome due to organ damage in glyphosate herbicide poisoning[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our data suggested that the q-SOFA score has moderate value in predicting the prognosis of poisoned patients (AUC 0.736,95%CI 0.684\u0026thinsp;~\u0026thinsp;0.787). Compared to ECG indicators (AUC 0.777,95%CI 0.728\u0026thinsp;~\u0026thinsp;0.827), the q-SOFA score has a high sensitivity, but lower specificity. One study demonstrated that ECG combined with q-SOFA score improved risk stratification for patients with acute pulmonary embolism[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Moreover, several reports indicate that combining heart rate variability with q-SOFA can effectively improve predictive ability for mortality in patients with sepsis[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These studies indicated that electrophysiological alterations might precede the appearance of cellular damage, ECG could be a useful supplement to the predictive efficiency of q-SOFA. Therefore, we explored the utility of combination of ECG and q-SOFA score for acute poisoning patients.\u003c/p\u003e \u003cp\u003eOur study revealed that ECG combined with q-SOFA score (AUC 0.808, 95%CI 0.763\u0026thinsp;~\u0026thinsp;0.852) had a better predictive value than PSS score (AUC 0.617, 95%CI 0.558\u0026thinsp;~\u0026thinsp;0.677, p\u003c0.05). In fact, the PSS score is a widely accepted tool for predicting the prognosis for poisoning[\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, PSS clinical utility is limited by its complexity and subjectivity[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Meanwhile, the score of ECG combined with q-SOFA seems more easy, objective and accuracy, which could be suitable for the acute poisoning patients with less information in stages of pre-hospital or triage in emergency department.\u003c/p\u003e \u003cp\u003eInevitably, our study has some limitations. Firstly, the data was obtained from single-center with its possible selection bias. Secondly, in order to eliminate the interference of previous cardiac diseases on ECG, we excluded patients with previous cardiac injury in this retrospective study. Thus, the results are not suitable for the acute poisoning patients with previous cardiac disease.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the ability of ECG combined with q-SOFA score to identify poor prognosis of pre-hospital acute poisoning is better that PSS score, meanwhile it has better accuracy and feasibility compared. The combination of ECG and q-SOFA score is promising for widespread clinical application.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eelectrocardiogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eq-SOFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuick Sequential Organ Failure Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe Poisoning Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe area under the cure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective clinical study was implemented according to the 1975 Declaration of Helsinki, and was approved by the Medical Ethics Committee of *** (Register number: 2018-170). Informed consent regarding the treatment risk following poisoning was obtained from all patients upon their initial admission within 24h. All data gathered from clinical patient records was anonymized and securely protected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the National Natural Science Foundation of China (81871550), the National Key R\u0026amp;D Program of China (2021YFC3002205) and the Key Specialty of Traditional Chinese Medicine in the 13th Five-Year Plan of Zhejiang Province.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026rsquo;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGH and SZ conceptualized and designed the study. WL, RY, M L, YJ and WC performed the study and acquired the data. YT and YX analyzed the data. WL and SZ drafted the manuscript. GH and YX revised the paper. GH and SZ contribute equally to this study. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the Information Centre staff in our hospital for general support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor details\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China. \u003csup\u003eb\u003c/sup\u003e Wenzhou Key Laboratory of emergency and disaster medicine, Wenzhou 325000, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Statistics. 2021: World Health Organization; 2021 [updated \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/bitstream/handle/10665/342703/9789240027053-eng.pdf]\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/bitstream/handle/10665/342703/9789240027053-eng.pdf]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282\u0026ndash;1501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConner KR, Wiegand TJ, Gorodetsky R, et al. Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self-poisoning. Behav Sci Law. 2019 May;37(3):240\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavies JO, Eddleston M, Buckley NA. Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. QJM. 2008 May;101(5):371\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Sarnagawy GN, Abdelnoor AA, Abuelfadl AA, et al. Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients. Environ Sci Pollut Res Int. 2022 May;29(23):33999\u0026ndash;4009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanderas-Bravo ME, Arias-Verdu MD, Macias-Guarasa I, et al. Patients Admitted to Three Spanish Intensive Care Units for Poisoning: Type of Poisoning, Mortality, and Functioning of Prognostic Scores Commonly Used. Biomed Res Int. 2017;2017:5261264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarzaneh E, Ghobadi H, Akbarifard M, et al. Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk-Prediction Nomogram Approach. Basic Clin Pharmacol Toxicol. 2018 Sep;123(3):347\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017 Jan;17(3):301\u0026ndash;8. 317(.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang C, Xu R, Zeng Y, et al. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS ONE. 2022;17(4):e0266755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho YS, Chun BJ, Moon JM. The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning. Basic Clin Pharmacol Toxicol. 2018 Nov;123(5):615\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho YS, Moon JM, Chun BJ, et al. Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department. Shock. 2019 Apr;51(4):447\u0026ndash;452.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsiguzo GC, Iroezindu MO, Muoneme AS, et al. Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria. Niger J Clin Pract. 2017 Sep;20(9):1133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMladenka P, Applova L, Patocka J, et al. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev. 2018 Jul;38(4):1332\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Gao X, Xiao Q, et al. Correlation Between QTc Dispersion and Soluble Growth-stimulating Gene 2 Protein on the Early Prognosis of Acute Carbon Monoxide Poisoning Heart Disease. J Cardiovasc Pharmacol. 2021 Oct 1;78(4):572\u0026ndash;580.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDostal V, Wood SD, Thomas CT, et al. Proteomic signatures of acute oxidative stress response to paraquat in the mouse heart. Sci Rep. 2020 Oct;28(1):18440. 10(.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos Ruybal MCP, Gallego M, Sottani TBB, et al. Methylmercury Poisoning Induces Cardiac Electrical Remodeling and Increases Arrhythmia Susceptibility and Mortality. Int J Mol Sci. 2020 May 15;21(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira G, Santander A, Chavarria L, et al. Functional consequences of lead and mercury exposomes in the heart. Mol Aspects Med. 2021 Nov;13:101048.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Nahhal Y, El-Nahhal I. Cardiotoxicity of some pesticides and their amelioration. Environ Sci Pollut Res Int. 2021 Sep;28(33):44726\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobison LB, Brady WJ, Robison RA, et al. QT interval prolongation and the rate of malignant ventricular dysrhythmia and cardiac arrest in adult poisoned patients. Am J Emerg Med. 2021 Aug;46:156\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarreiro S, Miller S, Wang B, et al. Clinical predictors of adverse cardiovascular events for acute pediatric drug exposures. Clin Toxicol (Phila). 2020 Mar;58(3):183\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLonghitano Y, Candelli M, Muir HA, et al. Non-infarctual ST elevation and acute cardiopulmonary failure in carbon monoxide poisoning: a case report. Eur Rev Med Pharmacol Sci. 2019 Aug;23(16):7128\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuniz AE. Valproic Acid Overdose Review of a Case With Electrocardiographic Changes. J Emerg Med. 2017 Sep;53(3):333\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurata K, Araki S, Yokoyama K, et al. Autonomic and peripheral nervous system dysfunction in workers exposed to mixed organic solvents. Int Arch Occup Environ Health. 1991;63(5):335\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Sarnagawy GN, Shaban AE, Lashin HI. Validation of Corrected and Dispersed QT as Predictors of Adverse Outcomes in Acute Cardiotoxicities. Cardiovasc Toxicol. 2022 Jan;22(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManini AF, Nair AP, Vedanthan R, et al. Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose. J Am Heart Assoc. 2017 Feb 3;6(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):762 \u0026ndash; 74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinger M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb;23(8):801\u0026ndash;10. 315(.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharitos IA, Topi S, Castellaneta F, et al. Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments. Antibiotics (Basel). 2019 May 7;8(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams JM, Greenslade JH, McKenzie JV, et al. Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection. Chest. 2017 Mar;151(3):586\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeng F, Chen YX, He XH, et al. Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism. Chin Med J (Engl). 2018 Oct;20(20):2395\u0026ndash;401. 131(.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamsudin MI, Liu N, Prabhakar SM, et al. A novel heart rate variability based risk prediction model for septic patients presenting to the emergency department. Med (Baltim). 2018 Jun;97(23):e10866.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrabhakar SM, Tagami T, Liu N, et al. Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department. PLoS ONE. 2019;14(3):e0213445.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun Y, Yang Y, Zhang Z, et al. Early enteral nutrition combined with PSS-based nursing in the treatment of organophosphorus pesticide poisoning. Am J Transl Res. 2021;13(8):9315\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRietjens SJ, Sikma MA, Hunault CC, et al. Pregabalin poisoning: Evaluation of dose-toxicity relationship. Br J Clin Pharmacol. 2022 Mar;88(3):1288\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang IJ, Yeom SR, Park SW, et al. Poison severity score and sequential organ failure assessment score: Carbon monoxide poisoning prognosis. PLoS ONE. 2019;14(3):e0212025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwarz ES, Kopec KT, Wiegand TJ, et al. Should We Be Using the Poisoning Severity Score? J Med Toxicol. 2017 Jun;13(2):135\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acute poisoning, ECG, q-SOFA score, PSS score, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-1960167/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1960167/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAcute poisoning is a worldwide and frequently occurring disease, endangering millions of people and leading to ten thousands of deaths every year. Early effective evaluation and appropriate treatment are the key to improve the clinical outcomes. However, early accurate assessment of the conditions in patients with acute poisoning is challenging. This study aimed to investigate the utility of electrocardiogram (ECG) combined with quick Sequential Organ Failure Assessment (q-SOFA) score as early prognostic predictors in acute poisoning patients. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe clinical data of acute poisoning patients were collected from 2016 to 2022 in a regional medical center. The statistical analysis was used to evaluate the risk factors related to prognosis based on their ECG. And the receiver operating characteristic (ROC) curve were used to evaluate the early diagnostic value of ECG combined with q-SOFA. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong the 572 patients, 119 patients belonged to the survived group and 453 patients belonged to the died. ECG abnormalities were detected in 71.3% of survivors and 88.2% of dead (p＜0.05). One variable analysis revealed that heart rate (HR), ECG axis, PR intervals, RV5, R+S, and ST-T change (all p＜0.05) of ECG had significant differences in the prognosis of patients between two groups. Multifactorial logistic results showed that HR (OR=1.035, 95%CI 1.026~1.044) and QTc (OR=1.013, 95%CI 1.007~1.019) were independent risk factors for death. ROC curve analysis revealed that the area under the cure (AUC) of ECG was 0.777 (95%CI 0.728~0.827), q-SOFA score was 0.736 (95%CI 0.684~0.787), PSS score was 0.617 (95%CI 0.558~0.677), and the prediction model constructed based on HR, QTc and q-SOFA score was 0.808 (95%CI 0.763~0.852), with the best diagnostic accuracy (50.4%). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eECG\u003cstrong\u003e \u003c/strong\u003ecombined with q-SOFA is a useful early predictor of poor outcome in acute poisoning patients. It has better accuracy and certain feasibility compared with PSS score.\u003c/p\u003e","manuscriptTitle":"Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-24 17:31:32","doi":"10.21203/rs.3.rs-1960167/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"670ca7ef-0b1f-4e82-9e32-b86830d0f729","owner":[],"postedDate":"August 24th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-10-14T06:05:48+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-24 17:31:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1960167","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1960167","identity":"rs-1960167","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}