Scorpion sting: N-terminal fragment of proB-type natriuretic peptide as an early predictor of pediatric cardiotoxicity

Abstract

Aim of the work: This prospective study was conducted to evaluate the clinical reliability of N-terminal fragment of proB-type natriuretic peptide (NT-proBNP) in identifying patients with cardiotoxicity in the early hours following scorpion sting. Subjects and methods: This study involved 483 children aging between 2–17 years who were admitted to Minia University Poisoning Control Center from 1st January 2010 to 31st December 2019 with a history of scorpion sting, and on clinical evaluation symptoms were manifested. All subjects were clinically examined, investigated for NT-proBNP and CPK-MB on admission, 6 h and 24 h post-envenomation; and subjected to 24 h cardiac monitoring with periodic ECG every 6 h. Results: Assessment of CPK-MB levels showed a significant increase in all moderate to severe cases 6 h post-envenomation. Assessment of NT-proBNP levels showed a significant increase in all moderate to severe cases on admission and 6 h post-envenomation. Moreover, there was a significant decrease in the NT-proBNP level after 24 h compared with that measured on admission. The sensitivity of NT-proBNP for the diagnosis of myocardial injury at hospital admission was significantly higher than that of CPK-MB. Conclusion: NT-proBNP may be a valuable and sensitive laboratory biomarker to predict cardiotoxicity of scorpion sting in the early hours.

Scorpion envenomation-associated myocarditis: A systematic review

“…Ventricular tachycardia was another important finding [ 71 , 75 , 76 , 84 ]. Laboratory findings associated with myocarditis were raised levels of cardiac troponin T [ 49 , 57 , 61 , 64 , 70 , 72 , 75 , 87 ], troponin I [ 34 , 41 , 42 , 45 , 46 , 49 , 58 , 60 , 65 , 66 , 74 , 76 , 78 , 79 , 81 , 82 , 84 – 86 , 88 , 91 , 92 ], unspecified-type troponin [ 63 , 67 , 80 , 82 ], CK-MB [ 14 , 18 , 34 , 37 , 40 , 45 , 46 , 49 , 52 , 57 , 59 , 62 , 66 , 68 , 70 , 74 – 76 , <...…”

“…Echocardiography findings in the studies included regional or global hypokinesia [ 13 , 26 , 34 , 36 – 38 , 45 , 48 , 51 , 52 , 54 , 57 , 59 , 61 , 62 , 67 , 71 , 72 , 75 – 77 , 79 , 81 , 83 – 87 , 90 , 91 ], chamber dilation [ 45 , 53 , 59 , 68 , 69 , 73 , 76 , 80 ], decreased left ventricular ejection fraction (LVEF) [ 13 , 14 , 18 , 26 , 34 , 36 – 41 , 45 , 46 , 48 , 49 , 51 – 55 , 57 – 75 , 77 – 93 ], decreased fractional shortening (FS) [ 37 , 38 , 41 , 48 , ...…”

“…Some studies focused on the diagnostic significance of cardiac biomarkers in scorpion stings [ 49 , 52 , 55 , 58 , 60 , 61 , 97 , 104 , 105 ]. While high troponin is a diagnostic criterion for myocarditis, it may not always indicate myocardial dysfunction [ 104 ].…”

“…Other studies showed that CK-MB is likely to be elevated in most envenomations (even those without cardiac dysfunction), while NT-proBNP and troponin are more specific markers of cardiac dysfunction [ 55 , 57 , 58 , 106 ]. Khalaf et al [ 52 ] found low sensitivity and specificity for CK-MB [ 57 ]. Natriuretic peptides, BNP and NT-proBNP, were investigated in some studies with varied results [ 49 , 52 , 58 , 61 , 105 ].…”

“…Khalaf et al [ 52 ] found low sensitivity and specificity for CK-MB [ 57 ]. Natriuretic peptides, BNP and NT-proBNP, were investigated in some studies with varied results [ 49 , 52 , 58 , 61 , 105 ]. While Gökay et al [ 49 ] and Prasad et al [ 58 ] showed a potential for NT-proBNP to predict myocardial dysfunction, Sofer et al [ 61 ] found that it has low sensitivity and specificity.…”