Aspiration-induced lung injury in acute drug and ethanol poisoning: incidence, risk factors, and clinical predictors

Introduction Aspiration-induced lung injury complicates acute poisoning due to impaired airway reflexes. This study aims to identify risk factors for aspiration-induced lung injury in acutely poisoned patients and evaluate the predictive value of the CRB-65 score, a tool for assessing the severity of community-acquired pneumonia in poisoning.Methods We performed a retrospective review of patients presenting with acute poisoning due to recreational drug use at one hospital between January 2019 and June 2021. Clinical data, laboratory findings, and radiological reports were analyzed. Logistic regression analysis was performed to identify independent risk factors. Additionally, the CRB-65 score was assessed for its ability to predict aspiration-induced lung injury in poisoned patients.Results Of 497 cases included, 34 patients (6.8%) diagnosed with aspiration-induced lung injury. The logistic regression model identified fever (OR 39.4, 95% CI: 3.0–522.3), dysrhythmia (OR 20.5, 95% CI: 1.4–290.5), respiratory insufficiency (OR 18.7, 95% CI: 2.9–119.4), sedation (OR 4.6, 95% CI: 1.5–14.3), long-term medication (OR 4.5, 95% CI: 1.3–15.9), and neuroleptic administration (OR 4.1, 95% CI: 1.3–13.7) as independent predictors. Aspiration-induced lung injury was also associated with confusion (P <0.001) and lower Glasgow Coma Scale scores (P <0.001). The CRB-65 score demonstrated a high negative predictive value (96.6%) but low specificity (46.1%).Discussion The observed incidence was lower than in comparable studies, likely due to varying diagnostic criteria, as no standardized definition exists. A negative CRB-65 score may help rule out aspiration-induced lung injury, but it is insufficient as a standalone diagnostic tool.Conclusion In acutely poisoned patients, aspiration-induced lung injury is associated with impaired consciousness, cardiovascular instability, and administration of neuroleptics or sedatives. While the CRB-65 score can help exclude aspiration-induced lung injury in low-risk patients, further diagnostic tools such as clinical examination, laboratory testing, and imaging remain necessary for confirmation.