Development of a risk-prediction nomogram for in-hospital adverse cardiovascular events in acute cardiotoxic agents poisoning

Abstract

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.

Keywords

• Nomogram
• Adverse Cardiovascular Events
• Acute poisoning
• Cardiotoxic Agents
• Validation
• Outcomes