Markers of cardiotoxicity as predictors for survival in acute anticholinesterase poisoning

Background: Consequential cardiac complications can occur following acute organophosphorus (OP) poisoning. Aim: to investigate the role of biochemical markers of cardiotoxicity including Troponin I(TnI), cardiac creatine kinase (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as predictors for survival in acute anticholinesterase poisoning. Methods: Twenty patients with severe organophosphorus poisoning admitted to the intensive care unit of the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) , were enrolled. Cases were categorized into survivors (n=11) and non-survivors (n=9). Clinical findings, electrocardiographic changes, and serum cardiac biomarkers measured on admission were analyzed in relation to outcome. Results: Hypotension was reported only among non-survivors. ECG abnormalities were recorded among all non-survivors in the form of elevated ST segment, inverted T wave, and prolonged QT interval. Statistically significant difference in relation to non-survival was found as regards sinus bradycardia, ST segment elevation, and respiratory failure requiring mechanical ventilation. Recorded cardiac biomarkers showed non-significant difference between survivors and non-survivors. Troponin I demonstrated the highest sensitivity for mortality prediction (100%), while CK-MB showed favorable combined sensitivity (75%) and specificity (90%). NT-proBNP exhibited high sensitivity but poor specificity. Conclusion: Cardiovascular complications are frequent in critically ill patients with acute organophosphorus poisoning. Specific electrocardiographic abnormalities and respiratory failure were associated with fatal outcomes. Early measurement of cardiac biomarkers may have limited diagnostic utility, although troponin I appears to be the most sensitive early indicator of mortality risk, with CK-MB representing a reasonable alternative.