Combined predictive value of dose, MODS, and NLR for lethal risk of diquat poisoning: a retrospective cohort study.
9 affiliations
- 1School of Public Health, North Sichuan Medical College, Nanchong, China.
- 2School of Public Health, Southern Medical University, Guangzhou, China.
- 3Department of Intensive Care Unit, Guangzhou Twelfth People's Hospital, Guangzhou, China.
- 4School of Preschool Education and Healthcare, Xiangzhong Preschool Education College, Shaoyang, China.
- 5Department of Internal Medicine-Cardiovascular, Guangzhou Twelfth People's Hospital, Guangzhou, China.
- 6Occupational Health Surveillance Center, Guangzhou Occupational Diseases Prevention and Treatment Center, Guangzhou, China.
- 7Department of Occupational Diseases and Poisoning, Guangzhou Twelfth People's Hospital, Guangzhou, China.
- 8Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China.
- 9Institute of Occupational and Environmental Health, Guangzhou Medical University, Guangzhou, China.
Abstract
Objective
Accurate risk assessment for fatal diquat poisoning is critical to improving clinical outcomes. Therefore, this study aimed to evaluate the combined value of the multiple organ dysfunction syndrome (MODS) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital all-cause mortality from acute diquat poisoning.Methods
This work retrospectively enrolled diquat self-poisoning patients in Guangzhou 12th People's Hospital between 2017 and 2023. Demographic, exposure, and 24-h laboratory data were extracted. A time-dependent Cox model evaluated MODS as a time-varying predictor. LASSO and logistic regression identified independent predictors and established the prediction equation; restricted cubic splines assessed dose-response. Bootstrap internal validation evaluated discrimination and calibration; however, variable selection was not repeated within each resample, and therefore the optimism-corrected performance metrics should be interpreted with caution. SHAP quantified feature contributions.Results
NLR was significantly elevated in non-survivors compared to survivors (median 31.37 vs. 11.19, P < 0.001). In the time-dependent Cox analysis, MODS remained independently associated with mortality (hazard ratio [HR] = 35.24, 95% CI: 13.57-91.50, P < 0.001). In the exploratory logistic regression, MODS (adjusted odds ratio [aOR] = 34.63, 95% CI: 7.47-245.65, P < 0.001), diquat dose (aOR = 1.34 per 10 mL, 95% CI: 1.22-1.63, P < 0.001), and NLR (aOR = 1.07, 95% CI: 1.02-1.13, P = 0.01) were independently associated with in-hospital all-cause mortality. The combined model achieved an AUC of 0.976 (Bootstrap 95% CI: 0.951-0.998), with an optimism-corrected AUC of 0.970, an apparent calibration intercept of 0, an apparent calibration slope of 1, and a Brier score of 0.0553 (95% CI: 0.0140-0.0775). SHAP values ranked feature importance as diquat dose (0.179) > MODS (0.145) > NLR (0.069). Sensitivity analyses confirmed the robustness of these findings.Conclusion
MODS and NLR were independently associated with in-hospital all-cause mortality in acute diquat poisoning. When applied after the first 24-72 h of admission, the combined model shows promise as a potential exploratory tool for risk stratification; however, external validation in larger multicenter cohorts is required before any consideration of bedside application.
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BibTeX
@article{dai2026combined,
title = {{Combined predictive value of dose, MODS, and NLR for lethal risk of diquat poisoning: a retrospective cohort study.}},
author = {Jifeng Dai and Meiyi He and Shi Chen and Yunchao Chen and Xin Li and Huaiman Ou and Yufan Deng and Caiying Zhong and Wenfeng Zeng and Yuquan Chen and Yanmei Ruan and Zhi Wang and Zejin Ou},
journal = {Frontiers in toxicology},
year = {2026},
month = oct,
doi = {10.3389/ftox.2026.1897012},
url = {https://europepmc.org/article/MED/42899089},
note = {CC BY},
}
RIS
TY - JOUR
TI - Combined predictive value of dose, MODS, and NLR for lethal risk of diquat poisoning: a retrospective cohort study.
AU - Jifeng Dai
AU - Meiyi He
AU - Shi Chen
AU - Yunchao Chen
AU - Xin Li
AU - Huaiman Ou
AU - Yufan Deng
AU - Caiying Zhong
AU - Wenfeng Zeng
AU - Yuquan Chen
AU - Yanmei Ruan
AU - Zhi Wang
AU - Zejin Ou
PY - 2026
DA - 2026/10/05
JO - Frontiers in toxicology
DO - 10.3389/ftox.2026.1897012
UR - https://europepmc.org/article/MED/42899089
AB - Objective Accurate risk assessment for fatal diquat poisoning is critical to improving clinical outcomes. Therefore, this study aimed to evaluate the combined value of the multiple organ dysfunction syndrome (MODS) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital all-cause mortality from acute diquat poisoning.Methods This work retrospectively enrolled diquat self-poisoning patients in Guangzhou 12th People's Hospital between 2017 and 2023. Demographic, exposure, and 24-h laboratory data were extracted. A time-dependent Cox model evaluated MODS as a time-varying predictor. LASSO and logistic regression identified independent predictors and established the prediction equation; restricted cubic splines assessed dose-response. Bootstrap internal validation evaluated discrimination and calibration; however, variable selection was not repeated within each resample, and therefore the optimism-corrected performance metrics should be interpreted with caution. SHAP quantified feature contributions.Results NLR was significantly elevated in non-survivors compared to survivors (median 31.37 vs. 11.19, P < 0.001). In the time-dependent Cox analysis, MODS remained independently associated with mortality (hazard ratio [HR] = 35.24, 95% CI: 13.57-91.50, P < 0.001). In the exploratory logistic regression, MODS (adjusted odds ratio [aOR] = 34.63, 95% CI: 7.47-245.65, P < 0.001), diquat dose (aOR = 1.34 per 10 mL, 95% CI: 1.22-1.63, P < 0.001), and NLR (aOR = 1.07, 95% CI: 1.02-1.13, P = 0.01) were independently associated with in-hospital all-cause mortality. The combined model achieved an AUC of 0.976 (Bootstrap 95% CI: 0.951-0.998), with an optimism-corrected AUC of 0.970, an apparent calibration intercept of 0, an apparent calibration slope of 1, and a Brier score of 0.0553 (95% CI: 0.0140-0.0775). SHAP values ranked feature importance as diquat dose (0.179) > MODS (0.145) > NLR (0.069). Sensitivity analyses confirmed the robustness of these findings.Conclusion MODS and NLR were independently associated with in-hospital all-cause mortality in acute diquat poisoning. When applied after the first 24-72 h of admission, the combined model shows promise as a potential exploratory tool for risk stratification; however, external validation in larger multicenter cohorts is required before any consideration of bedside application.
SN - 2673-3080
ER -