Background: Acute poisoning is a worldwide and frequently occurring disease, endangering millions of people and leading to ten thousands of deaths every year. Early effective evaluation and appropriate treatment are the key to improve the clinical outcomes. However, early accurate assessment of the conditions in patients with acute poisoning is challenging. This study aimed to investigate the utility of electrocardiogram (ECG) combined with quick Sequential Organ Failure Assessment (q-SOFA) score as early prognostic predictors in acute poisoning patients. Methods: The clinical data of acute poisoning patients were collected from 2016 to 2022 in a regional medical center. The statistical analysis was used to evaluate the risk factors related to prognosis based on their ECG. And the receiver operating characteristic (ROC) curve were used to evaluate the early diagnostic value of ECG combined with q-SOFA. Results: Among the 572 patients, 119 patients belonged to the survived group and 453 patients belonged to the died. ECG abnormalities were detected in 71.3% of survivors and 88.2% of dead (p＜0.05). One variable analysis revealed that heart rate (HR), ECG axis, PR intervals, RV5, R+S, and ST-T change (all p＜0.05) of ECG had significant differences in the prognosis of patients between two groups. Multifactorial logistic results showed that HR (OR=1.035, 95%CI 1.026~1.044) and QTc (OR=1.013, 95%CI 1.007~1.019) were independent risk factors for death. ROC curve analysis revealed that the area under the cure (AUC) of ECG was 0.777 (95%CI 0.728~0.827), q-SOFA score was 0.736 (95%CI 0.684~0.787), PSS score was 0.617 (95%CI 0.558~0.677), and the prediction model constructed based on HR, QTc and q-SOFA score was 0.808 (95%CI 0.763~0.852), with the best diagnostic accuracy (50.4%). Conclusion: ECG combined with q-SOFA is a useful early predictor of poor outcome in acute poisoning patients. It has better accuracy and certain feasibility compared with PSS score.