Combined routine blood and urine laboratory indicators are efficient predictors of prognosis in patients with acute paraquat poisoning: a retrospective study

Acute paraquat poisoning is associated with high mortality, necessitating practical prognostic tools to improve clinical outcomes. This study aimed to develop a composite index using routine blood and urine parameters to predict prognosis and guide personalized treatment strategies. Data from patients with acute paraquat poisoning hospitalized between January 2009 and June 2024 were divided into training and validation cohorts. Ridge regression analysis was conducted to identify key prognostic factors, and receiver operating characteristic curve analysis was performed to assess predictive performance. Principal component analysis was used to assign relative weights to predictors and construct a composite index, which was subsequently validated in an independent cohort. Ridge regression and receiver operating characteristic curve analyses identified the amount of paraquat ingested, absolute neutrophil count, urine protein concentration, serum bicarbonate concentration, serum creatinine concentration, and blood glucose concentration as independent prognostic factors. The composite index demonstrated an area under the receiver operating characteristic curve of 0.921, with an optimal diagnostic threshold of 4.35. The predictive efficacy of the composite index for death was largely consistent across both the training (n = 268) and validation sets (n = 31). When the score was ≥5, the probability of predicting mortality was 94%. The study highlights the utility of routine laboratory parameters in constructing a simple and accurate prognostic tool. Despite its strengths, including high predictive accuracy, limitations such as single-center design and potential biases should be noted. Multicenter prospective validation is recommended to generalize findings and improve early intervention strategies. The combined use of amount of paraquat ingested, absolute neutrophil count, urine protein concentration, serum bicarbonate concentration, serum creatinine concentration, and blood glucose concentration in a composite index provides a reliable tool for early prognosis prediction and personalized management in paraquat poisoning cases.