A Prospective Comparative Study between Three Chemical Markers for Predicting Delayed Neurological Sequelae in Patients with Acute Carbon Monoxide Poisoning of Poison Control Center in Minia University Hospital.

Abstract

Carbon monoxide poisoning (CO) is a major public health problem. Brain is the most sensitive organ to hypoxia induced by CO poisoning. Delayed Neurological Sequelae (DNS) is considered to be a delayed onset of neuropsychiatric symptoms after apparent recovery from acute CO poisoning. Therefore, this study was aimed to make a prospective comparative study between three markers (serum glutathione reductase, S100b protein and serum neurone-specific enolase) to predict the occurrence of DNS. This study was performed on 57 adult patients with acute CO poisoning. The markers were measured after arrival and the patients were divided into two groups: the DNS group (8 patients) & the non-DNS group (49 patients). There was a statistical difference between the two groups in terms of significant increase in loss of consciousness, syncope, dizziness, ECG changes, pneumonia, carboxyhemoglobin level, creatine phosphokinase, creatine phosphokinase-MB, troponin I, S100b protein, neurone-specific enolase in DNS grouped patiens and significant decrease in glasgow coma scale and glutathione reductase in DNS group. The cut off value of glutathione reductase was ≤ 30 U/L with a percentage of accuracy 94. 74. The cut off value of S100b protein was > 18.94 Pg/ L with 98.25 % percentage of accuracy, while, the cut off value of neurone-specific enolase was > 30.49 ng/ml and its accuracy was 96.49 %. All these cut off values predicted the occurrence of DNS. SO, it is concluded that serum S100b protein may represent the most reliable chemical marker for the prediction of DNS after acute CO poisoning by logistic regression analysis.

S-100β in predicting the need of hyperbaric oxygen in CO-induced delayed neurological sequels

“…57 Follow-up of our patients for 6 months after discharge showed that DNS manifestations were reported by six patients (12%), which is nearly similar to the rates (14-16.5%) reported by previous studies. 46,47,58,59 However, both higher rates (24.1-26%) 21,60 and lower rates of DNS (9.8%) 23 were also found in other studies. These discrepancies in the incidence of DNS among the studies may be due to various factors such as the age of the studied patients, the duration of exposure to CO, the delay before receiving medical care, and the concentration of the gas.…”

“…Moreover, Pepe et al, 21 Moon and Kim, 60 Kudo et al, 58 and Kitamoto et al 59 found a lack of correlation between COHb level and DNS. Also, Di et al 67 and Hassan et al 46 reported that serum S-100b levels were significantly higher in patients with DNS. Kim et al 23 found that serum S-100b protein level was independently associated with DNS.…”

“…This finding is in line with previous studies that reported higher serum levels of S-100b in CO-poisoned patients with disturbed consciousness. 34,36,41,43,46 However, Rasmussen et al 44 reported the lack of significant increase in serum S-100b level in CO-poisoned patients with a GCS less than 13. However, their study was conducted on a small sample size, 20 patients, which may impact their results.…”

“…In addition, Hassan et al 46 conducted an ROC curve analysis to examine serum S-100b as a predictor of DNS and found that S-100b is an excellent predictor (AUC ¼ 0.990), with 87.5% sensitivity and 100% specificity at a cutoff value >18.9 Pg/L. Kim et al 23 found S-100b to have an AUC of 0.85 with 90% sensitivity and 84.8% specificity at a cutoff value above 0.103 mg/L.…”

“…36,40 Also, previous studies have evaluated S-100b level as an indicator of the severity of CNS affection in CO-poisoned patients. 34,36,[41][42][43][44][45] However, only a few studies 46,47 have investigated its utility as an indicator of HBO therapy that could decrease the incidence of DNS. Therefore, the current study aimed to evaluate serum S-100b level in patients presenting with acute CO poisoning as an indicator of poisoning severity as well as a predictor of DNS occurrence and the need of HBO therapy in those patients.…”