Predictors of ICU Admission in Patients with Acute Exposure to Cardiotoxic Agents: A Prospective Study.

Abstract

Background: In cases of acute poisoning from cardiotoxic agents, it is crucial to recognize early patients who may require advanced medical support to guide timely clinical decision-making. Aim of the work: The current study aimed to determine clinical and biochemical predictors of ICU admission among patients with acute exposure to cardiotoxic agents. Patients and Methods: This prospective observational study included patients exposed to cardiotoxic agents at the Alexandria Poison Centre, conducted from January to June 2023. Results: The mean age of the patients was 32.9 years, and 66% were male. 26% of the patients were admitted to the ICU. Upon analysis of their data, a significant association was found between ICU admission and the presence of non-cardiac comorbidities (p=0.009), Poisoning Severity Score (PSS) (p=<0.001), serum potassium abnormalities (p=0.019), diminished serum bicarbonate (p=0.034), and decreased ejection fraction, recorded by Echocardiogram (p=0.001). Multivariate regression analysis revealed that the likelihood of ICU admission was increased in the presence of comorbidities, metabolic acidosis, and decreased ejection fraction, by about 12, 7, and 51 times, respectively (OR=11.978, 7.428, and 50.590, respectively). Upon ROC curve analysis, diminished ejection fraction had the highest discriminatory power, followed by comorbidities and low HCO3 levels (AUC=0.807, 0.709, and 0.682, respectively). Conclusion: This work suggests that the presence of comorbidities, low serum bicarbonate level, and diminished ejection fraction are reliable and clinically applicable predictors that can be universally applied to acute cardiotoxicities, regardless of the causative toxic agent.