• August Supervía, Antonio F Caballero-Bermejo, Jordi Puiguriguer, Francisca Córdoba, Andrea Martínez-Baladrón, Francisco Callado, Victoria Lobo-Antuña, Elena Fuentes, Valle Molina-Samper, Susana Vert, Francisco Ruíz-Ruíz, F Javier Guijarro-Eguinoa, Beatriz Martín-Pérez, Samuel Olmos, Belén Ruiz-Antorán, María Teresa Maza-Vera, Oriol Pallàs, Benjamín Climent, Maider Igartua-Astibia, Edith Gutiérrez, Santiago Nogué, Ana Ferrer-Dufol, and Guillermo Burillo-Putze.
• Emergency Department, Hospital del Mar, Barcelona, Spain; Functional Clinical Toxicology Unit, Parc de Salut Mar, Barcelona, Spain; Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox), Spain; Fundación Española de Toxicología Clínica, Spain.
• Am J Emerg Med. 2024 Jul 1; 81: 929892-98.

BackgroundDigoxin poisonings are relatively common and potentially fatal, requiring immediate therapeutic intervention, with special attention to the patient's hemodynamic status and the presence of electrocardiographic and electrolytic disturbances.ObjectiveTo identify factors associated with seven-day and thirty-day mortality in digoxin poisoning.Design, Settings And ParticipantsA retrospective, observational, multicenter study was conducted across 15 Hospital Emergency Departments (HED) in Spain. All patients over 18 years of age who presented to participating HEDs from 2015 to 2021 were included. The inclusion criteria encompassed individuals meeting the criteria for digoxin poisoning, whether acute or chronic.Outcomes Measure And AnalysisTo identify independent factors associated with 7-day and 30-day mortality, a multivariate analysis was conducted. This analysis included variables of clinical significance, as well as those exhibiting a trend (p < 0.1) or significance in the bivariate analysis.Main FindingsA total of 658 cases of digoxin poisoning were identified. Mortality rates were 4.5% (30 patients) at seven days and 11.1% (73 patients) at thirty days. Regarding 7-day mortality, the mean age of deceased patients was comparable to survivors (84.7 (8.9) vs 83.9 (7.9) years; p = ns). The multivariate analysis revealed that factors independently associated with 7-day mortality encompassed the extent of dependence assessed by the Barthel Index (BI 60-89 OR 0.28; 95% CI 0.10-0.77; p = 0.014 and BI>90 OR 0.22; 95% CI 0.08-0.63; p = 0.005), the identification of ventricular arrhythmias (OR 1.34; 95% CI 1.34-25.21; p = 0.019), and the presence of circulatory (OR 2.84; 95% CI 1.19-6.27; p = 0.019) and neurological manifestations (OR 2.67; 95% CI 1.13-6.27; p = 0.025). Factors independently associated with 30-day mortality encompassed extent of dependence (BI 60-89 OR 0.37; 95% CI 0.20-0.71; p = 0.003 and BI>90 OR 0.18; 95% CI 0.09-0.39; p < 0.001) and the identification of circulatory (OR 2.13; 95% CI 1.10-4.15; p = 0.025) and neurological manifestations (OR 2.39; 95% CI 1.25-3.89; p = 0.006).ConclusionsThe study identifies the degree of dependency assessed by the Barthel Index and the presence of cardiovascular and neurological symptoms as independent predictors of both 7-day and 30-day mortality. Additionally, the detection of ventricular arrhythmia is also an independent factor for 7-day mortality.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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