Clinical, Biochemical, and Electrocardiographic Predictors of Mortality in Acute Aluminum Phosphide Poisoning

Aluminum phosphide (AlP) poisoning is among the deadliest pesticide poisonings, particularly in developing agricultural communities, with multiorgan involvement significantly affecting the poisoned patient's outcome.

To evaluate the prognostic significance of arterial blood gas (ABG), serum troponin I, cortisol, renin, early ECG abnormalities, and the Simplified Acute Physiology Score II (SAPS II) in predicting the outcome of acute AlP poisoning during the first 24 h postingestion.

A prospective cohort study was conducted on 42 patients with confirmed acute AlP ingestion who met the inclusion criteria at Zagazig University Hospitals. All patients underwent thorough history-taking, clinical assessment, routine laboratory investigations, and selected specific tests, including ECG assessment, measurement of serum troponin I, cortisol, and renin, ABG analysis, and finally SAPS II scoring. Patients were categorized as survivors or nonsurvivors. The predictive ability of several parameters for mortality was assessed using the t-test and ROC curve analysis.

Mortality rate was 59.5%. Abnormal ECGs were significantly more common in nonsurvivors (p < 0.001). Renin (AUC = 0.81) and cortisol (AUC = 0.69) demonstrated fair-to-good predictive accuracy, whereas troponin I showed poor prognostic value (AUC = 0.48). SAPS II demonstrated very high discriminatory performance (AUC = 1.00). SAPS II also correlated positively with serum cortisol and renin, and negatively with pH, bicarbonate, and base excess.

SAPS II had the highest validity as a mortality predictor for AlP poisoning, followed by bicarbonate, base excess, renin, pH, and cortisol, arranged in descending order according to their AUC. ECG evaluation is also a reliable early predictor of mortality. These parameters can aid early risk stratification and guide timely intensive management.