COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning

Kaya, Hakan; Coşkun, Abuzer; Beton, Osman; Zorlu, Ali; Kurt, Recep; Yücel, Hasan; Güneş, Hakan; Yılmaz, Mehmet

doi:10.1016/j.ajem.2016.01.036

Cited by 32 publications

(27 citation statements)

References 43 publications

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“…Up to one-third of patients with moderate to severe CO poisoning present with myocardial injury, which may be associated with increased long-term mortality (48)(49)(50). Higher levels of COHb are associated with both acute and long-term development of myocardial infarction (51). In one study, over half of CO-poisoned patients who were deemed eligible for HBO 2 due to CO poisoning were found with reduced left ventricular function (52).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Follow-up is recommended within 1-2 months of poisoning to assess the development of neurocognitive deficits, depression, or anxiety, and, if present, this requires referral for neurocognitive evaluation (12). Additional care and attention should be given to standard medical issues as well, with the increased risk of myocardial infarction (51). More research should be performed on the longterm follow-up of patients with CO poisoning, as there are clear long-term consequences to survivors.…”

Section: Long-term Consequences and Follow-upmentioning

confidence: 99%

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Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy

Rose

Wang

Xu³

et al. 2017

Am J Respir Crit Care Med

544

472

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Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1 to 3%. A significant number of patients who survive CO poisoning suffer from long-term neurological and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation, and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15-40% of patients, whereas approximately one-third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction, and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed posthypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. Although hyperbaric oxygen significantly reduces the permanent neurological and affective effects of CO poisoning, a portion of survivors still have substantial morbidity. There has been some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Section: Long-term Consequences and Follow-upmentioning

confidence: 99%

Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy

Rose

Wang

Xu³

et al. 2017

Am J Respir Crit Care Med

544

472

View full text Add to dashboard Cite

show abstract

“…In our study, most patients were women and the mean age was 55 years. Kaya et al 26 , reported an incidence of 60% of women and age mean was 36.36 years while in Durak study 27 72% were male with an age mean of 33 years. Coşkun et al 28 study showed a 60% of women with an age mean of 53 years.…”

Section: Discussionmentioning

confidence: 89%

Risk of late appearance of acute myocardial infartion after carbon monoxide (CO) intoxication

Karaman

Coşkun

2019

Rev. méd. Chile

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Background: After acute carbon monoxide intoxication, there may be a higher risk for late adverse cardiac events. However, these patients are usually not followed to monitor the appearance of these effects. Aim: To follow patients seen at an emergency department for carbon monoxide intoxication, monitoring the appearance of myocardial infarction. To assess the predictive value for such complication of serum troponin, carboxyhemoglobin, and procalcitonin levels at the moment of intoxication. Material and Methods: We followed 237 patients receiving emergency care for carbon monoxide intoxication, with a serum carboxyhemoglobin of 5% or more, between 2010 and 2012. Levels of procalcitonin and troponin I were measured. Patients were followed for five years after the intoxication. Results: During the follow up period, 35 patients had a myocardial infarction. These patients had significantly higher carboxyhemoglobin, procalcitonin and troponin I levels at the moment of the intoxication than their counterparts who did not had a myocardial infarction in the follow up. A logistic regression analysis showed that age, carboxyhemoglobin levels, procalcitonin, troponin 1 and length of CO exposure were associated with a higher risk of myocardial infarction. Procalcitonin, troponin and carboxyhemoglobin levels had a high sensitivity and specificity to predict the appearance of myocardial infarction, with high areas under the receiver operating characteristic (ROC) curves. Conclusions: In patients with CO intoxication, carboxyhemoglobin, troponin and procalcitonin levels at the moment of the intoxication are significant predictors of the late appearance of myocardial infarction.

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“…However, fatalities due to CO poisoning have been reported for COHb levels between 3 and 70% [27]. One recent study concerning chronic total exposure to CO via COHb levels defined CO poisoning based on medical history and COHb% of >5% [29]. …”

Section: Introductionmentioning

confidence: 99%

Carboxyhaemoglobin Levels among Traders Exposed to Vehicular Emissions in Three Motor Parks in Ibadan, Nigeria

Ogunseye

Ana

Uhiara

et al. 2018

Journal of Environmental and Public Health

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Carbon monoxide (CO) remains a leading cause of work-related chemical poisoning. Vehicular emissions are the primary daily ambient source of CO in urban Nigerian motor parks, where there have been few human exposure studies. Using a cross-sectional comparative design, we assessed carboxyhaemoglobin levels (% COHb), a biomarker of CO exposure, among traders at three motor parks (AMP, IMP, and NMP) and other traders (nonmotor park workers) in Ibadan, Nigeria, using a noninvasive pulse CO-dosimeter (Rad 57). Ninety-three traders were proportionally allocated between motor parks; 93 other traders were selected based on specific study inclusion criteria. Mean ages of motor park traders and other traders were comparable, 37.8 ± 11.1 and 38.7 ± 9.6, respectively. Mean % COHb for traders (range 3–22) at AMP, IMP, and NMP was 11.2 ± 3.8, 11.6 ± 3.1, and 12.2 ± 3.3, respectively, while mean % COHb for other traders was about three times lower, 4.1 ± 1.7 (range 2–8). Overall, mean % COHb for motor park traders, 11.7 ± 3.3, was also significantly higher than for other traders (p < 0.05). Nevertheless, mean % COHb for both groups exceeded the current World Health Organization guideline, 2.5%. This study suggested that motor park traders have higher % COHb and thus are highly susceptible to exposure and more vulnerable to known risks of adverse health effects from exposure to CO.

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COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning

Cited by 32 publications

References 43 publications

Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy

Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy

Risk of late appearance of acute myocardial infartion after carbon monoxide (CO) intoxication

Carboxyhaemoglobin Levels among Traders Exposed to Vehicular Emissions in Three Motor Parks in Ibadan, Nigeria

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