An In-Hospital Mortality Prediction Model for Acute Pesticide Poisoning in the Emergency Department

Pesticide poisoning remains a significant public health issue, characterized by high morbidity and mortality, particularly among patients presenting to the emergency department. This study aimed to develop a 14-day in-hospital mortality prediction model for patients with acute pesticide poisoning using early clinical and laboratory data. This retrospective cohort study included 1056 patients who visited Soonchunhyang University Cheonan Hospital between January 2015 and December 2020. The cohort was randomly divided into train (n = 739) and test (n = 317) sets using stratification by pesticide type and outcome. Candidate predictors were selected based on univariate Cox regression, LASSO regularization, random forest feature importance, and clinical relevance derived from established prognostic scoring systems. Logistic regression models were constructed using six distinct feature sets. The best-performing model combined LASSO-selected and clinically curated features (AUC 0.926 [0.890-0.957]), while the final model-selected for interpretability-used only LASSO-selected features (AUC 0.923 [0.884-0.955]; balanced accuracy 0.835; sensitivity 0.843; specificity 0.857; F1.5 score 0.714 at threshold 0.450). SHapley Additive exPlanations (SHAP) analysis identified paraquat ingestion, Glasgow Coma Scale, bicarbonate level, base excess, and alcohol history as major mortality predictors. The proposed model outperformed the APACHE II score (AUC 0.835 [0.781-0.888]) and may serve as a valuable tool for early risk stratification and clinical decision making in pesticide-poisoned patients.