When Inflammation Fails to Resolve: Serial CRP–Albumin and Neutrophil-to-Lymphocyte Trajectories Predict Multiorgan Dysfunction in Acute Pesticide Poisoning

Résumé fourni par la source

Background: Acute pesticide poisoning can progress rapidly to multiple organ dysfunction syndrome (MODS), and inexpensive dynamic biomarkers for early risk stratification are needed. Objective: To evaluate whether serial C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio (NLR) predicted MODS and adverse outcomes in acute pesticide poisoning. Methods: This prospective cohort study included 160 adults admitted to St. Gregrios Medical Hospital, Parumala, Kerala from November 2025 to May 2026. NLR and CAR were measured at admission, 24 hours, and 48 hours. SOFA scores and clinical outcomes were recorded. ROC analysis and multivariable logistic regression assessed predictive performance. Results: MODS developed in 52 (32.5%) patients. NLR and CAR were significantly higher in the MODS group at alltime points, with the greatest separation at 48 hours. Forty-eight-hour CAR >1.50 predicted MODS with an AUC of 0.91, while 48-hour NLR >10 yielded an AUC of 0.88. CAR >1.50, NLR >10, and admission SOFA ≥6 remained independent predictors of MODS. MODS was also associated with greater mechanical ventilation, vasopressor requirement, acute kidney injury, and mortality. Conclusion: Serial CAR and NLR, particularly 48-hour values, may provide accessible dynamic markers for early identification of patients at high risk of organ dysfunction after acute pesticide poisoning in routine clinical toxicology practice. Keywords: Acute pesticide poisoning; C-reactive protein-to-albumin ratio; Multiple organ dysfunction syndrome; Neutrophil-to-lymphocyte ratio; Prognostication.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.