{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:45:20Z","timestamp":1792075520294,"version":"4.4.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To assess the prognostic value of the mean Lethality Risk Score (LRS), reflecting the toxicity of substances involved in an exposure, and to develop prediction models for complicated outcomes in ICU patients with acute intoxication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Multicenter prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Seventy-eight ICUs in Europe, Australia, and the Eastern Mediterranean (2020\u20132023).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>A total of 2265 adult patients were admitted to the ICU with acute intoxication as the main reason for admission for at least 4 hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention:<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results:<\/jats:title>\n                    <jats:p>The primary outcome was defined as ICU complications or death (22.5%). Clinical data were collected in an electronic capture system. We developed two prediction models: one incorporating laboratory variables (\u201cLaboratory Model\u201d), and one including the mean LRS (\u201cExpo Model\u201d). The mean LRS was calculated as the average of the individual LRS values assigned to the toxicants involved in the exposure. Key predictors were age, severity at presentation, systolic blood pressure, Glasgow Coma Scale score, and hospital type. The mean LRS remained significant only when laboratory variables were not considered. Model performance was assessed using the area under the receiver operating characteristic (AUROC), calibration plots, likelihood ratio tests, and decision curve analysis. Internal validation demonstrated good performance for both models (AUROCs of 0.79 and 0.77; calibration slopes of 0.94 and 0.95; intercepts of \u22120.06 and \u20130.06), with minimal overfitting. Decision curve analysis revealed clinically relevant threshold probability ranges of 0\u201350% for the Laboratory Model and 0\u201340% for the Expo Model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The mean LRS had prognostic value only in the absence of laboratory test results. Both models may aid decision-making regarding the management of acutely intoxicated patients in the ICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007376","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:00:34Z","timestamp":1792072834000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Developing Models for Complicated Outcomes in Acutely Intoxicated ICU Patients With and Without Toxicity Information"],"prefix":"10.1097","author":[{"given":"Samanta M.","family":"Zwaag","sequence":"first","affiliation":[{"name":"Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"van Sabben","sequence":"additional","affiliation":[{"name":"Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, The Netherlands."},{"name":"Division of Toxicology, Wageningen University, Wageningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma S.","family":"van den Hengel-Koot","sequence":"additional","affiliation":[{"name":"Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Baker","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Druw\u00e9","sequence":"additional","affiliation":[{"name":"Intensive Care, Ghent University Hospital, Ghent, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Elhadi","sequence":"additional","affiliation":[{"name":"College of Medicine, Korea University, Seoul, South Korea."},{"name":"Faculty of Medicine, University of Tripoli, Tripoli, Libya."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Ferrer","family":"Dufol","sequence":"additional","affiliation":[{"name":"Unit of Clinical Toxicology, Clinic University Hospital, Saragossa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sune","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcin","family":"Halacli","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, T\u00fcrkiye."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jung","sequence":"additional","affiliation":[{"name":"Klinik F\u00fcr Kardiologie, Pneumologie Und Angiologie Universit\u00e4tsklinikum D\u00fcsseldorf, D\u00fcsseldorf, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabija","family":"Laubner Sakalauskien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Uppsala University Hospital, Uppsala, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Moreno","sequence":"additional","affiliation":[{"name":"Hospital de S\u00e3o Jos\u00e9, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisboa, Portugal."},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade da Beira Interior, Covilh\u00e3, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Rabe","sequence":"additional","affiliation":[{"name":"Department of Clinical Toxicology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanna","family":"Reiter","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark."},{"name":"Danish Poison Information Center, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Rezar","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Intensive Care, Clinic of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, 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