Key result
A risk-prediction nomogram incorporating modified shock index, HCO3, O2 saturation, and ECG parameters predicted adverse cardiovascular events with 89.2% accuracy and an AUC of 0.956.
Why the study?
Adverse cardiovascular events are serious sequelae of acute cardiotoxic agent poisoning, and early identification of high-risk patients could improve prognosis.
Can a risk-prediction nomogram accurately predict in-hospital adverse cardiovascular events in patients with acute cardiotoxic agent poisoning?
Cohort (n=186)
No
Can a risk-prediction nomogram accurately predict in-hospital adverse cardiovascular events in patients with acute cardiotoxic agent poisoning?
p-value: p=<0.001
A newly developed nomogram using clinical, laboratory, and ECG parameters can accurately predict in-hospital adverse cardiovascular events in patients with acute cardiotoxic poisoning.
May aid ACVE risk stratification in poisoning; leaves open external validation before clinical use.
Adverse cardiovascular events (ACVE) are serious sequelae of acute poisoning with cardiotoxic agents. They include shock, acute myocardial injury, ventricular dysrhythmias, and cardiac arrest. Early identification of high-risk patients could improve their prognosis. Therefore, this study developed a risk-prediction nomogram to assess the risk of ACVE in patients with acute cardiotoxicities. This prospective cohort study was conducted at Tanta University Poison Control Center, Tanta, Egypt, from April 2023 to March 2024. It included 186 patients with acute cardiotoxic agent poisoning. ACVE occurred in 36 % of patients and were significantly associated with ICU admission and mortality ( P <0.001). A multivariable logistic regression model was generated that included six significant predictors; modified shock index (AOR of 6.431, 95 % CI: 1.361–30.398, P = 0.02), serum bicarbonate level (AOR of 0.747, 95 % CI: 0.661–0.843, P = 0.001), oxygen saturation (AOR of 0.867, 95 % CI: 0.810–0.929, P = 0.001), ST segment changes (AOR of 9.196, 95 % CI: 1.989–42.508, P = 0.011), prolonged QTc (AOR of 3.015, 95 % CI: 0.975–9.325, P = 0.044), and QRS width (AOR of 1.032, 95 % CI: 1.001–1.064, P = 0.009). The nomogram was statistically significant ( P <0.001) and could predict ACVE with 89.2 % accuracy. A Receiver Operating Characteristics analysis was conducted to ensure the nomogram's discrimination ability (Area under the curve =0.956). Also, the calibration curve was drawn using the bootstrapping method to ensure the nomogram’s internal validity. The current study provided an easily applicable nomogram that could accurately predict ACVE following acute cardiotoxicities, regardless of the causative agent. • Adverse cardiovascular events (ACVE) are serious sequelae of cardiotoxic agents poisoning. • Nomogram predictors were modified shock index, HCO 3 , O 2 saturation, and ECG parameters. • ECG parameters of the nomogram were ST segment changes, prolonged QTc, and QRS width. • The adopted nomogram predicted ACVE probability with 89.2 % accuracy and AUC was 0.956. • Nomogram was internally validated using a bootstrapping method and calibration curve.
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Lashin et al. (2024) conducted a cohort in Acute cardiotoxic agent poisoning (n=186). Risk-prediction nomogram was evaluated on Adverse cardiovascular events (ACVE) (p=<0.001). A risk-prediction nomogram incorporating modified shock index, HCO3, O2 saturation, and ECG parameters predicted adverse cardiovascular events with 89.2% accuracy and an AUC of 0.956.
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