Evaluation of Serum Erythropoietin Level and Selected Hematological Parameters as Early Biomarkers of Acute Hydrogen Cyanamide (Dormex) Toxicity

Abstract

Acute hydrogen cyanamide (Dormex) toxicity is associated with hypoxia-mediated cellular injury; however, reliable early biomarkers for assessing toxicity severity remain limited. This study aimed to evaluate serum erythropoietin (EPO) and selected hematological parameters as biomarkers associated with toxicity severity, with a comparative assessment of their diagnostic performance. Forty participants were allocated into four groups: control, mild, moderate, and severe toxicity. Clinical assessment, arterial blood gases, coagulation profile, a complete blood count, random blood sugar, renal function tests, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and serum EPO level, were performed upon admission. Radiological evaluation using computed tomography of the brain was conducted, with magnetic resonance imaging performed when indicated. Significant differences were observed among the studied groups in white blood cell count, neutrophil count, and NLR at admission. Serum EPO levels showed a highly significant increase with increasing severity of toxicity. Strong positive correlations were identified between serum EPO, NLR, and severity of toxicity, whereas significant negative correlations were found with Glasgow Coma Scale scores. Receiver operating characteristic (ROC) analysis demonstrated that serum EPO had the highest discriminative ability for assessing toxicity severity, with superior sensitivity, specificity, and overall accuracy compared to the evaluated hematological indices in the present cohort. However, given the relatively small study population, particularly the limited number of patients with severe toxicity (n = 8), and the absence of external validation, the observed discriminative performance should be interpreted cautiously and validated in larger independent multicenter studies. Serum EPO and selected hematological indices, particularly NLR, are valuable biomarkers for early assessment of severity in acute Dormex toxicity. EPO, in particular, represents a promising early biomarker for assessing the severity of acute hydrogen cyanamide poisoning, reflecting underlying hypoxia-driven pathophysiology and outperforming traditional hematological indices such as NLR and PLR.