Predictive Value of Albumin-Corrected Anion Gap for Secondary Acute Myocardial Injury in Patients With Acute Pesticide Poisoning.

AIMS/

BACKGROUND

Acute pesticide poisoning frequently results in secondary acute myocardial injury. Identifying predictive biomarkers, such as albumin-corrected anion gap (ACAG), is crucial for early intervention. This study aimed to explore the predictive value of ACAG for secondary acute myocardial injury in patients with acute pesticide poisoning.

METHODS

A retrospective analysis was conducted on 205 patients with acute pesticide poisoning admitted between March 2017 and December 2024. Patients were classified into a myocardial injury group (n = 81) and a non-myocardial injury group (n = 124) based on the presence of secondary acute myocardial injury. Univariate and binary logistic regression analyses were employed to identify factors influencing secondary acute myocardial injury. Pearson or Spearman correlation analysis was used to analyze the correlation between variables, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ACAG.

RESULTS

No statistically significant differences were observed between the two groups in terms of age, gender, body mass index (BMI), pesticide type, admission time, hemoglobin (Hb), white blood cell (WBC) count, platelet count (PLT), renal insufficiency, or admission heart rate (p > 0.05). The myocardial injury group had significantly higher anion gap (AG) and ACAG values, incidence of respiratory failure, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and number of severe poisoning cases compared to the non-myocardial injury group (p < 0.05). Albumin levels were significantly lower in the myocardial injury group (p < 0.05). Correlation analysis revealed that ACAG was negatively correlated with albumin (r = -0.528, p < 0.05) and positively correlated with AG and APACHE II scores (r = 0.974, 0.365, p < 0.05). Respiratory failure was negatively correlated with albumin (r = -0.160, p < 0.05) and positively correlated with APACHE II scores (r = 0.206, p < 0.05). Severe poisoning showed a negative correlation with albumin (r = -0.217, p < 0.05) and positive correlations with ACAG and AG (r = 0.230, 0.199, p < 0.05). Binary logistic regression analysis showed that ACAG (odds ratio (OR) = 1.586, p < 0.001), respiratory failure (OR = 4.432, p = 0.001), APACHE II score (OR = 1.242, p < 0.001), and severe poisoning (OR = 3.472, p = 0.008) were significant influencing factors for secondary acute myocardial injury in patients with acute pesticide poisoning. ROC analysis results showed that ACAG had an area under the curve (AUC) of 0.859 (95% confidence interval [CI]: 0.809-0.909, p < 0.001), with a standard error of 0.025, a Youden index of 0.55, sensitivity of 59.26%, and specificity of 95.97%. Patients with ACAG ≤24.54 had significantly higher survival probability and better post-treatment cardiac function indicators than those with ACAG >24.54 (p < 0.05).

CONCLUSION

ACAG has strong predictive value for secondary acute myocardial injury in patients with acute pesticide poisoning. It is recommended that ACAG be routinely assessed upon admission in these patients.