Human fatty acid binding protein as an early predictive biomarker for carbon monoxide induced cardiotoxicity

Elhelaly, Hend; Anwar, Somih; Mostafa, Suzan

doi:10.21608/mjmr.2022.217546

Human fatty acid binding protein as an early predictive biomarker for carbon monoxide induced cardiotoxicity

Document Type : Original Article

Authors

¹ Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University.

² Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University

10.21608/mjmr.2022.217546

Abstract

Background: Carbon monoxide (CO) poisoning has deleterious cardiac effects which necessitate
proper diagnoses and assessment using ECG and cardiac biomarkers; CKMB and troponinI. Human
fatty acid-binding protein (H-FABP) recently used as a new cardiac marker as it is identifiable in
serum by myocardial cell destruction. Aim of the work: To assess the role of H-FABP as an early
predictor biomarker for CO induced cardiotoxicity. Patients and Methods: A prospective
observational study was conducted on 25 adult (18-65years old) with diagnosis of acute CO poisoning
of both sex, admitted to Poison Control Center of Ain shams University Hospitals (PCCASUH) from
November 2015 to April 2016. Patients were divided into; moderately intoxicated cases7 patients
(Group 1) and severely intoxicated patients18 patients (Group 2). Cardiac assessment was done
through ECG recording and analysis for (CKMB, CtnI and HFABP) serum level for all patients. This
was done on (ER) (hour 0), after 6 hours and after 24 hours of admission. Results: The study
recorded; chest pain 40%, syncope 60% and shock 28% in all patients which were more in group2
than that in group 1 and that was significant. Group2 developed more significant ischemic ECG
changes than group 1. The mean CK-MB and troponin I level showed increase with high level at
6th hour than 0hour and then decreased at 24th hour in both groups and that was statistically
significant. Group 2 had significant higher mean serum H-FABP level compared to group 1 at 6th
and 24th hour. Which tend to decrease continuously at 0hour, 6th hour and 24th hour in both groups
this decrease with time was significant. In-addition, it showed decreasing sensitivity with time (0, 6
and 24hours) in both groups and that was significant. As well as it showed increasing specificity with
time (0, 6 and 24hours) in both groups and that also was significant. Conclusion and
recommendations: Proper diagnosis and assessment of CO induced cardiac injury using ECG,
cardiac enzymes, and even echocardiography is necessary. Measurement of H-FABP is useful
sensitive indicator identifying early cardiac injury in CO poisoning with recommendation to be used
as bedside test for acute CO poisoning patients presented with chest pain as it is more sensitive than
troponinI.

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