title: Acute salicylate poisoning: risk factors for severe outcome.
abstract: BACKGROUND
  Salicylate poisoning remains a significant public health threat with more than 20,000 exposures reported annually in the United States.
  
  
  OBJECTIVE
  We aimed to establish early predictors of severe in-hospital outcomes in Emergency Department patients presenting with acute salicylate poisoning.
  
  
  METHODS
  This was a secondary data analysis of adult salicylate overdoses from a prospective cohort study of acute drug overdoses at two urban university teaching hospitals from 2009 to 2013. Patients were included based on confirmed salicylate ingestion and enrolled consecutively. Demographics, clinical parameters, treatment and disposition were collected from the medical record. Severe outcome was defined as a composite occurrence of acidemia (pH <7.3 or bicarbonate <16 mEq/L), hemodialysis, and/or death.
  
  
  RESULTS
  Out of 1997 overdoses screened, 48 patients met inclusion/exclusion criteria. Patient characteristics were 43.8% male, median age 32 (range 18-87), mean initial salicylate concentration 28.1 mg/dL (SD 26.6), and 20.8% classified as severe outcome. Univariate analysis indicated that age, respiratory rate, lactate, coma, and the presence of co-ingestions were significantly associated with severe outcome, while initial salicylate concentration alone had no association. However, when adjusted for salicylate concentration, only age (OR 1.13; 95% CI 1.02-1.26) and respiratory rate (OR 1.29; 95% CI 1.02-1.63) were independent predictors. Additionally, lactate showed excellent test characteristics to predict severe outcome, with an optimal cutpoint of 2.25 mmol/L (78% sensitivity, 67% specificity).
  
  
  CONCLUSIONS
  In adult Emergency Department patients with acute salicylate poisoning, independent predictors of severe outcome were older age and increased respiratory rate, as well as initial serum lactate, while initial salicylate concentration alone was not predictive.
authors.affiliation: a Mount Sinai Emergency Medicine Residency Program, Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Shively
authors.affiliation: b Division of Medical Toxicology, Ronald O. Pereleman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: c Division of Medical Toxicology, Department of Emergency Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.|d Department of Emergency Medicine , Elmhurst Hospital Center , New York , NY , USA.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Manini
mesh_terms: D000138:Acidosis / Q000139:chemically induced* / Q000453:epidemiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D062787:Drug Overdose; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D012459:Salicylates / Q000506:poisoning*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D012459:Salicylates
keywords: Aspirin; mortality; toxicity