{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:51:44Z","timestamp":1791208304297,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Toxicol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This work retrospectively enrolled diquat self-poisoning patients in Guangzhou 12th People\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      NLR was significantly elevated in non-survivors compared to survivors (median 31.37 vs. 11.19,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). In the time-dependent Cox analysis, MODS remained independently associated with mortality (hazard ratio [HR] = 35.24, 95% CI: 13.57\u201391.50,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). In the exploratory logistic regression, MODS (adjusted odds ratio [aOR] = 34.63, 95% CI: 7.47\u2013245.65, P &amp;lt; 0.001), diquat dose (aOR = 1.34 per 10\u00a0mL, 95% CI: 1.22\u20131.63,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), and NLR (aOR = 1.07, 95% CI: 1.02\u20131.13,\n                      <jats:italic>P<\/jats:italic>\n                      = 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\u20130.998), 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\u20130.0775). SHAP values ranked feature importance as diquat dose (0.179) &amp;gt; MODS (0.145) &amp;gt; NLR (0.069). Sensitivity analyses confirmed the robustness of these findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MODS and NLR were independently associated with in-hospital all-cause mortality in acute diquat poisoning. When applied after the first 24\u201372\u00a0h 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/ftox.2026.1897012","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:55:15Z","timestamp":1791204915000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined predictive value of dose, MODS, and NLR for lethal risk of diquat poisoning: a retrospective cohort study"],"prefix":"10.3389","volume":"8","author":[{"given":"Jifeng","family":"Dai","sequence":"first","affiliation":[{"name":"School of Public Health, North Sichuan Medical College","place":["Nanchong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiyi","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, North Sichuan Medical College","place":["Nanchong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunchao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[{"name":"School of Preschool Education and Healthcare, Xiangzhong Preschool Education College","place":["Shaoyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiman","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine-Cardiovascular, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufan","family":"Deng","sequence":"additional","affiliation":[{"name":"School of Public Health, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiying","family":"Zhong","sequence":"additional","affiliation":[{"name":"School of Public Health, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Occupational Health Surveillance Center, Guangzhou Occupational Diseases Prevention and Treatment Center","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuquan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanmei","family":"Ruan","sequence":"additional","affiliation":[{"name":"Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]},{"name":"Institute of Occupational and Environmental Health, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]},{"name":"Institute of Occupational and Environmental Health, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zejin","family":"Ou","sequence":"additional","affiliation":[{"name":"Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital","place":["Guangzhou, China"]},{"name":"Institute of Occupational and Environmental Health, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1016\/j.ajem.2014.09.001","article-title":"Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: Short- and long-term outcomes","volume":"32","author":"Akilli","year":"2014","journal-title":"Am. 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