Characteristics and predictive factors of severe or fatal suicide outcome in patients hospitalized due to deliberate self-poisoning

Abstract

Prediction of clinical course of intoxication is essential for timely initiation of appropriate medical treatment in patients hospitalized due to suicidal self-poisoning. In this retrospective single-centre study in patients hospitalized due to suicidal poisoning in a specialized clinical toxicology unit, we aimed to identify predictive factors associated with severe or fatal course of self-poisoning. All patients underwent at least one psychiatric exploration during their inpatient stay. Severity of poisoning was assessed on admission and after 24 hours according to the Poison Severity Score index (PSS). Spearman’s rank correlation coefficient was used to test the association of PSS with sociodemographic, anamnestic and (pre-)clinical parameters. Multivariable binomial logistic regression analysis was performed to determine predictive factors for severe and/or fatal self-poisoning. 1090 patients were included in the study. Median age was 39 years (range 13–91), 66.7% of patients were female. PSS was classified in the majority as “minor” (n = 558, 51.2%) or “moderate” (n = 264, 24.2%). 61 patients (5.6%) had PSS “severe”; 14 patients (1.3%) died. A higher severity of poisoning positively correlated with duration of inpatient therapy (p<0.001, Spearman’s rho = 0.454) and duration of ventilation (p<0.001, rho = 0.474), and it inversely correlated with initial Glasgow Coma Scale (GCS) score (p<0.001, rho = -0.437). Multivariable analysis identified no alcohol co-ingestion (OR 3.23; 95%CI 1.3, 8.07; p = 0.012) and self-poisoning with non-medicinal substances (OR 5.4; 95%CI 1.78, 16.34; p = 0.003) as factors predictive for “severe” or “fatal” suicide outcome. In contrast, female gender (OR 0.4; 95%CI 0.2, 0.81; p = 0.011), not using an antidepressant as the method for self-poisoning (OR 0.27; 95%CI 0.12, 0.59; p = 0.001) and a higher initial GCS score (OR 0.79; 95%CI 0.73, 0.85; p<0.001) reduced the risk of a severe or fatal course of self-poisoning. The conclusion for clinical practice is that male patients hospitalized due to self-poisoning, with a low initial GCS score, who did not co-ingest alcohol, attempted suicide with non-pharmaceutical substances or antidepressants are at a higher risk of severe/fatal outcome of suicide. Determination of these risk factors at admission could be potentially used to guide treatment intensification in patients hospitalized due to deliberate self-poisoning.

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

“…[6,18,19] The identification and treatment of poisoned people can be extremely difficult in the absence of clinical experience. [6,[20][21][22] Regional poison centers have been set up in a number of nations to address this problem and provide poisoned patients with expert care. [23][24][25][26][27][28][29][30] Poison centers have just recently been established in China.…”

“…This differs from the typical scenario of acute poisoning, where the majority of cases are attributed to suicide. [21,28,30] The disparities among poisoning populations can account for this phenomenon.…”

Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study

“…Although male sex was previously identified as a determinant of admission to critical care among self-poisoned patients who attempted suicide [7,8], we did not confirm this finding and observed that patient sex was not a determinant of admission to critical care in presentations to the ED with acute recreational drug toxicity. A recent retrospective single-center study at a specialized clinical toxicology unit showed that male sex increased the odds of a severe course of self-poisoning with suicidal intention [16], confirming the evidence that suicide-related behaviors in males, including self-poisoning, are often characterized by a more serious outcome [17][18][19]. Conversely, with regard to drug use for recreational purposes, a previous study by Miro et al within the Euro-DEN Plus database showed that when the admission to critical care was considered a marker of severity of acute recreational drug toxicity, no sex differences emerged from regression analyses adjusted by age, regardless of the type and number of drugs used [20].…”

A Cross-Sectional Analysis of Intentionally Self-Inflicted Poisoning Among Hospitalized Patients.

“…The accessibility of these agents, influenced by factors such as lax regulations and easy availability, contributes to their frequent use in intentional self-poisoning. Recognizing the patterns of substance use is vital for implementing targeted preventive measures, including stricter control over access to potentially harmful agents and educational initiatives on the risks associated with specific substances [15][16][17]. The reported 14% of participants with a history of previous suicidal attempts aligns with a meta-analysis by Hawton et al [18], indicating that a history of selfharm is a significant predictor of future attempts.…”