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Elsayed EA, Eweda SA, El-Morsy SA. Assessment of the role of N-terminal pro-B-type natriuretic peptide as a predictive biomarker of mortality in acute aluminum phosphide poisoning. Biomarkers 2024:1-8. [PMID: 39234754 DOI: 10.1080/1354750x.2024.2400910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND In Egypt, aluminum phosphide (ALP) is a known lethal poison due to its cardiotoxicity. This study aimed to evaluate the predictive ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality in ALP-poisoned patients. METHODS This prospective study was conducted on patients with ALP poisoning admitted to the Poison Control Center Ain Shams University Hospitals between July and December 2022. Upon admission, all patients were followed up and had their levels of NT-proBNP, troponin I (cTnI), and creatine kinase myocardial band (CK-MB) analyzed. RESULTS Thirty patients were enrolled in the study and were divided into survivors and non-survivors. The initial NT-proBNP levels were significantly higher among non-survivors in contrast to the initial cTnI and CK-MB levels. The study identified that the best cutoff point of NT-proBNP for predicting mortality was ≥72 pg/ml, with AUC (0.869). CONCLUSION It can be concluded that NT-proBNP can serve as an early predictor of mortality in ALP poisoning.
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Affiliation(s)
- Emad Ahmed Elsayed
- Department of Forensic Medicine and Clinical toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarah Atef Eweda
- Department of Forensic Medicine and Clinical toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarah Ahmad El-Morsy
- Department of Forensic Medicine and Clinical toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Yılmaz FH, Arı Yuca S, Vatansev H, Cimbek EA, Şen Y, Yılmaz İ, Akyürek F, Arslan D, Çimen D, Yorulmaz A. Heart-Type Fatty Acid Binding Protein Level as a Tool in Identification of Early Cardiac Effects of Diabetic Ketoacidosis. J Clin Res Pediatr Endocrinol 2017; 9:118-123. [PMID: 28077344 PMCID: PMC5463283 DOI: 10.4274/jcrpe.3961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aimed to measure the serum levels of heart-type fatty acid binding protein (H-FABP) in patients presenting with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) and to determine its role in identifying early-period cardiac ischemia. METHODS This prospective study included 35 patients diagnosed with DKA, 20 patients diagnosed with DK, and 20 control subjects. H-FABP, creatine kinase-MB (CK-MB), and troponin I levels were investigated at presentation in patients with DKA and DK and in the control group. H-FABP values were measured again after acidosis correction in the DKA patients. RESULTS No statistically significant differences were found with respect to troponin I and CK-MB within the groups. The H-FABP values of DKA patients at presentation were found to be significantly higher than those of DK patients and the control group (p=0.015). The H-FABP value of the DKA group was also found to be significantly higher than the value at hour 36 after acidosis correction (p=0.0001). CONCLUSION We would like to propose H-FABP as a potential marker for indicating myocardial ischemia.
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Affiliation(s)
- Fatma Hilal Yılmaz
- Selçuk University Faculty of Medicine, Department of Child Health and Diseases, Konya, Turkey, Phone: 0090332 224 39 88 E-mail:
| | - Sevil Arı Yuca
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Hüsamettin Vatansev
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Emine Ayça Cimbek
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Yaşar Şen
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - İsa Yılmaz
- Selçuk University Faculty of Medicine, Department of Child Health and Diseases, Konya, Turkey
| | - Fikret Akyürek
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Derya Arslan
- Konya Training and Research Hospital, Clinic of Pediatric Cardiology, Konya, Turkey
| | - Derya Çimen
- Selçuk University Faculty of Medicine, Department of Pediatric Cardiology, Konya, Turkey
| | - Alaaddin Yorulmaz
- Beyhekim State Hospital, Clinic of Child Health and Diseases, Konya, Turkey
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Baydin A, Amanvermez R, Çelebi HE, Tunçel ÖK, Demircan S. Pentraxin 3, ischemia-modified albumin, and myeloperoxidase in predicting a cardiac damage in acute carbon monoxide poisoning. Am J Emerg Med 2016; 34:1927-1930. [PMID: 27567420 DOI: 10.1016/j.ajem.2016.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Carbon monoxide (CO) poisoning is associated with cardiac injuries or manifestations, frequently attributing to direct hypoxic damage at cellular level. For this, the aims were to evaluate the role of serum pentraxin 3 (PTX 3), ischemia-modified albumin (IMA), and myeloperoxidase (MPO) as an early biomarker for cardiac damage when compared to cardiac troponin I (cTnI) and creatine kinase-MB fraction (CK-MB) in adult patients with acute CO poisoning. METHODS Forty patients with acute CO poisoning admitted to the emergency department. The patients were divided into 2 main groups as follows: cardiac injury (group I, n=19) and nonsuspected cardiac injury (group II, n=21). Pentraxin 3, IMA, MPO, cTnI, CK-MB, and the other assays in the circulation were measured on admission. RESULTS Upon measuring the serum PTX 3, IMA, MPO, cTnI, and CK-MB levels as well as large electrocardiography and echocardiography abnormalities of patients with cardiac injury on admission, no statistical difference for PTX 3, IMA, and MPO was found between the groups (P>.05). However, cTnI, CK-MB, and leukocyte count (white blood cell) were higher determined in patients of group I compared to group II (P<.05). Receiver operating characteristic curve was also performed to evaluate the diagnostic performance of these tests in patients with cardiac injury. CONCLUSIONS Our results suggest that PTX, IMA, and MPO assays are not superior to cTnI and CK-MB in predicting a cardiac damage in patients with acute CO intoxication.
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Affiliation(s)
- Ahmet Baydin
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey.
| | - Ramazan Amanvermez
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Hüseyin E Çelebi
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Özgür K Tunçel
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Sabri Demircan
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
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Zaky A, Ahmad A, Dell'Italia LJ, Jahromi L, Reisenberg LA, Matalon S, Ahmad S. Inhaled matters of the heart. ACTA ACUST UNITED AC 2015; 2. [PMID: 26665179 DOI: 10.14800/crm.997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inhalations of atmospheric pollutants, especially particulate matters, are known to cause severe cardiac effects and to exacerbate preexisting heart disease. Heart failure is an important sequellae of gaseous inhalation such as that of carbon monoxide. Similarly, other gases such as sulphur dioxide are known to cause detrimental cardiovascular events. However, mechanisms of these cardiac toxicities are so far unknown. Increased susceptibility of the heart to oxidative stress may play a role. Low levels of antioxidants in the heart as compared to other organs and high levels of reactive oxygen species produced due to the high energetic demand and metabolic rate in cardiac muscle are important in rendering this susceptibility. Acute inhalation of high concentrations of halogen gases is often fatal. Severe respiratory injury and distress occurs upon inhalation of halogens gases, such as chlorine and bromine; however, studies on their cardiac effects are scant. We have demonstrated that inhalation of high concentrations of halogen gases cause significant cardiac injury, dysfunction, and failure that can be critical in causing mortalities following exposures. Our studies also demonstrated that cardiac dysfunction occurs as a result of a direct insult independent of coexisting hypoxia, since it is not fully reversed by oxygen supplementation. Therefore, studies on offsite organ effects of inhaled toxic gases can impact development of treatment strategies upon accidental or deliberate exposures to these agents. Here we summarize the knowledge of cardiovascular effects of common inhaled toxic gases with the intent to highlight the importance of consideration of cardiac symptoms while treating the victims.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama ; Department of Medicine, Birmingham Veteran Affairs Medical Center, Birmingham, Alabama and Division of Cardiovascular Disease, University of Alabama Medical Center, Birmingham, Alabama
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama
| | - Louis J Dell'Italia
- Department of Medicine, Birmingham Veteran Affairs Medical Center, Birmingham, Alabama and Division of Cardiovascular Disease, University of Alabama Medical Center, Birmingham, Alabama
| | - Leila Jahromi
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama
| | - Lee Ann Reisenberg
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama
| | - Sadis Matalon
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Alabama
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Erenler AK, Yardan T, Baydin A, Gunay M, Amanvermez R. Heart-type fatty acid-binding protein as a potential biomarker of acute carbon monoxide poisoning. Am J Emerg Med 2013; 31:1165-9. [PMID: 23809096 DOI: 10.1016/j.ajem.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the role of serum heart-type fatty acid-binding protein (H-FABP) in the evaluation of patients with carbon monoxide (CO) poisoning. METHODS Forty patients with acute CO poisoning admitted to the emergency department and 15 healthy adults as the control group were included in the study. Serum H-FABP levels of patients were studied on admission and at the 6th, 12th, and 18th hours. Patients were divided into 3 groups according to clinical severity as mild, moderate, and severe. Patients were also divided into 2 groups according to treatment with hyperbaric oxygen (HBO) or normobaric oxygen. RESULTS Serum H-FABP levels of the patients were higher than those of the control group. There was a negative correlation between H-FABP levels and Glasgow Coma Scale score on admission. Heart-type fatty acid-binding protein levels were significantly higher in patients in the severe compared with mild group. Heart-type fatty acid-binding protein levels in patients treated with HBO were significantly higher than in those treated with normobaric oxygen. The cutoff value of serum H-FABP as an indicator for HBO treatment was determined as 1.5 ng/mL or higher, with a sensitivity of 85.7% and specificity of 69.7%. Serial measurement revealed that H-FABP level peaked at the sixth hour and reduced over time but remained higher than in the control group at the 18th hour. CONCLUSION Heart-type fatty acid-binding protein may be a promising novel biomarker in the evaluation of clinical severity and in the selection of patients for HBO therapy in acute CO poisoning.
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Affiliation(s)
- Ali Kemal Erenler
- Hitit University, Çorum Education and Research Hospital, Department of Emergency Medicine, Çorum, Turkey
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Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem 2012; 45:1278-85. [PMID: 22705450 DOI: 10.1016/j.clinbiochem.2012.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/30/2012] [Accepted: 06/05/2012] [Indexed: 02/04/2023]
Abstract
The toxicity of carbon monoxide has been recognized for long throughout history and is unquestionably the leading cause of unintentional poisoning deaths in the Western countries. The severity of poisoning is dependent upon environmental and human factor. The leading pathophysiological mechanism resides in the ability of carbon monoxide to bind to hemoglobin molecules with high affinity, displacing oxygen and generating carboxyhemoglobin, which is virtually ineffective to deliver oxygen to the tissues. The organs with the highest demand for oxygen such as the brain and the heart are more vulnerable to injury. Myocardial involvement is commonplace in moderate to severe carbon monoxide poisoning and is associated with a substantially higher risk of mortality. Besides hypoxic damage, carbon monoxide produces myocardium injuries with cardiospecific mechanisms, mostly attributable to direct damage at cellular or subcellular level. The clinical spectrum of heart involvement is broad and encompasses cardiomyopathy, angina attack, myocardial infarction, arrhythmias and heart failure up to myocardial stunning, cardiogenic shock and sudden death. Patients with underlying cardiac disease, especially coronary heart disease, are at greater risk of infarction and arrhythmias. Single photon emission computed tomography (SPECT) is the technique of choice for diagnosing cardiac involvement, whereas the recent introduction of the highly sensitive troponin immunoassays seems promising for the early triage of patients. No specific treatment other than oxygen delivery can be advocated for cardiac toxicity at present, and 100% oxygen therapy should be continued until the patient is asymptomatic and carboxyhemoglobin levels decrease below 5-10%.
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Affiliation(s)
- Giuseppe Lippi
- UO Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Koylu R, Cander B, Dundar ZD, Koylu O, Akilli NB, Ivelik K. The Importance of H-FABP in Determining the Severity of Carbon Monoxide Poisoning. J Clin Med Res 2012; 3:296-302. [PMID: 22393341 PMCID: PMC3279474 DOI: 10.4021/jocmr675w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 11/08/2022] Open
Abstract
Background In this study, we aimed to investigate the importance of the use of heart-type fatty acid binding protein (H-FABP) in evaluating the myocardial damage in patients admitted to the emergency department with moderate to severe carbon monoxide (CO) poisoning. Methods All patients admitted to the emergency department with severe acute CO intoxication were enrolled the study. The H-FABP and cardiac biomarker levels were assessed at 0, 6th and 24th hours. The patients were divided into groups as those with normal echocardiography findings and with wall motion abnormalities. The differences between the groups for these parameters were compared. Results The mean age of 80 patients was 32.3 ± 12.9 years old. 42 of them were male. On admission, 29 (36.3%) had elevated serum troponin I levels and 56 (70.0%) had elevated serum H-FABP levels. At 6thhour, 4 (5.0%) of 80 patients had higher serum H-FABP levels and 23 (28.8%) of them had higher serum Troponin I levels than 0 hour. The patients with wall motion abnormality had significantly higher serum H-FABP levels compared to the patients with normal echocardiography findings at 6th and 24th hours (p = 0.001 and 0.009). While the serum COHb and H-FABP levels tended to decrease continuously in time (p < 0.001), the serum troponin I levels increased at 6th hour and then decreased at 24th hour (p = 0.017). Conclusion The serum H-FABP levels are useful in identifying the myocardial damage in patients admitted to the emergency department with moderate to severe carbon monoxide poisoning at an early phase. Keywords Carbon monoxide; Poisoning; H-FABP; Myocardial injury
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Affiliation(s)
- Ramazan Koylu
- Konya Training and Research Hospital, Emergency Department, Konya, Turkey
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