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Hongyu Han,1,* Lihua Gao,2,* Han Cui,1 Dan Li,3 Yanan Hou,4 Jing Jiang,5 Hongna Sun11Poisoning Intensive Care Unit, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, Tangshan City, Hebei Province, People’s Republic of China; 2Department of Nephrology, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, Tangshan City, Hebei Province, People’s Republic of China; 3Department of Emergency, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, Tangshan City, Hebei Province, People’s Republic of China; 4Cadre Ward, Comprehensive Internal Medicine, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, Tangshan City, Hebei, Province, People’s Republic of China; 5Pathology and Blood Transfusion Department, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, Tangshan City, Hebei, Province, People’s Republic of China*These authors contributed equally to this studyCorrespondence: Hongna Sun, Poisoning Intensive Care Unit, 982nd Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force, No. 24, National Defense Road, Lunan District, Tangshan City, Hebei Province, 063005, People’s Republic of China, Tel +86 13303051907, Email sunhongnayme@163.comBackground: Acute poisoning remains a major emergency and toxicology problem, but its clinical pattern differs by toxin type and local availability. Diquat poisoning is increasingly reported where paraquat use has been restricted, whereas metamizole exposure remains relevant in regions where dipyrone remains clinically available.Objective: This retrospective observational cohort study described clinical characteristics, treatment patterns and prognostic factors in acute poisoning involving diquat, single-drug pharmaceutical exposure and mixed-drug exposure.Methods: We analysed 385 adults with confirmed acute poisoning treated at a single tertiary toxicology centre from January to June 2025. Patients were classified as Group A (diquat, n = 125), Group B (single-drug poisoning, predominantly metamizole, n = 143) or Group C (mixed-drug poisoning, n = 117). Baseline features, laboratory findings, interventions and 30-day outcomes were compared. A presentation-based logistic regression model assessed mortality predictors, and early haemoperfusion was analysed separately in the diquat subgroup.Results: Group A had the highest 30-day mortality (28.8%) compared with Group B (5.6%) and Group C (14.5%) (p < 0.001). Liver injury, renal dysfunction, cardiac biomarker elevation, lactate elevation and acidosis were most pronounced after diquat exposure. In the diquat subgroup, haemoperfusion within 6 hours was associated with lower mortality than delayed haemoperfusion (17.1% vs 47.6%, p < 0.001), including after propensity score matching. Diquat poisoning, delayed presentation, low Glasgow Coma Scale score, hypotension, elevated lactate, renal dysfunction, acidosis and early multi-organ dysfunction were associated with mortality.Conclusion: Acute poisoning showed heterogeneous clinical patterns by toxic agent category. Diquat poisoning carried the greatest mortality and multi-organ injury, whereas mixed-drug poisoning showed intermediate severity. Early haemoperfusion was associated with improved outcomes in diquat poisoning, but causal interpretation is limited by the retrospective design; prospective multicentre validation is needed.Keywords: acute poisoning, diquat, metamizole, mixed-drug poisoning, haemoperfusion, prognosis |