White blood cell count as a prognostic and mechanistic mediator in acute diquat poisoning: a retrospective cohort study enabling risk stratification for resource-limited settings

BACKGROUND: Diquat poisoning is associated with high mortality, and accurate prognostication remains challenging in resource-limited settings. This retrospective cohort study evaluated white blood cell count (WBC) as both a prognostic biomarker and mechanistic mediator in acute diquat poisoning. METHODS: This retrospective cohort included 134 patients with acute diquat poisoning (2016-2025). WBC was analysed continuously and categorically (median and ROC-derived cut-offs). Multivariable regression, subgroup, and mediation analyses were performed. RESULTS: /L, comparable to plasma diquat concentration's AUC of 0.817 (95% CI: 74.4%-88.9%). CONCLUSIONS: /L, providing a practical risk-stratification framework for settings lacking toxicological testing.