Development and validation of a risk prediction nomogram for disposition of acute clozapine intoxicated patients to intensive care unit

被引:0
|
作者
Sharif, Asmaa F. [1 ,2 ]
Aouissi, Ha [3 ,4 ,5 ]
Kasemy, Zeinab A. [6 ]
Byeon, H. [7 ,8 ]
Lashin, Heba I. [1 ]
机构
[1] Tanta Univ, Fac Med, Forens Med & Clin Toxicol Dept, Tanta, Egypt
[2] Dar Al Uloom Univ, Coll Med, Dept Clin Med Sci, Riyadh, Saudi Arabia
[3] Sci & Tech Res Ctr Arid Reg CRSTRA, Biskra, Algeria
[4] Univ Sci & Technol USTHB, Lab Rech & Etude Amenagement & Urbanisme LREAU, Algiers, Algeria
[5] Badji Mokhtar Annaba Univ, Environm Res Ctr CRE, Annaba, Algeria
[6] Menoufia Univ, Fac Med, Publ Hlth & Community Med Dept, Shibin Al Kawm, Egypt
[7] Inje Univ, Dept Digital Antiaging Healthcare BK21, Gimhae, South Korea
[8] Inje Univ, Dept Digital Antiaging Healthcare BK21, Gimhae 50834, Gyeonsangnamdo, South Korea
基金
新加坡国家研究基金会;
关键词
Acute clozapine intoxication; intensive care unit admission; nomogram; risk stratification; external validation;
D O I
暂无
中图分类号
R99 [毒物学(毒理学)];
学科分类号
100405 ;
摘要
BackgroundClozapine is an atypical antipsychotic drug used for the treatment of refractory schizophrenia. It is reported as the most toxic in its class. Using serum clozapine level as a severity indicator is doubtful and unfeasible, particularly in low resourced countries. MethodsThis is an extended two-phase retrospective study that utilized medical records of patients diagnosed with acute clozapine intoxication and admitted to Tanta University Poison Control Center, Egypt during the past 6 years. Two hundred and eight medical records were used to establish and validate a nomogram for predicting the need for intensive care unit (ICU) admission in acute clozapine intoxicated patients. ResultsA reliable simple bedside nomogram was developed and proved its significant ability to predict the need for ICU admission, with an area under the curve (AUC) of 83.9% and 80.8% accuracy. It encompassed the age of admitted patients (AUC = 64.8%, p = .003), respiratory rate (AUC = 74.7%, p < .001), O-2 saturation (AUC = 71.7%, p < .001), and random blood glucose level upon admission (AUC = 70.5%, p < .001). External validation of the proposed nomogram showed a high AUC (99.2%) with an overall accuracy of 96.2%. ConclusionThere is a need to develop a reliable objective tool predicting the severity and need for ICU admission in acute clozapine intoxication. The proposed nomogram is a substantially valuable tool to estimate ICU admission probabilities among patients with acute clozapine intoxication and will help clinical toxicologists make rapid decisions for ICU admission, especially in countries with low resources.
引用
收藏
页数:19
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