Evaluation of hepatic injury in acute carbon monoxide-poisoned patients in emergency department

Abstract

Introduction: The affinity of hemoglobin for carbon monoxide (CO) is 250 times higher than that for oxygen. Therefore, exposure to CO leads to a reduction in oxygen delivery to tissues, resulting in cellular hypoxia and affects whole body. Hepatic dysfunction in critically ill patients is related to poor outcome, but few studies have been conducted on this subject that occurs after CO poisoning. This study aims to conduct a study of hepatic injury in CO-poisoned patients in emergency department (ED). Methods: This retrospective observational study collected data from patients who were diagnosed with acute CO poisoning at the ED between June 2011 and May 2018 in local tertiary-care hospital (Wonju, Republic of Korea). The primary end point of this study was to describe the prevalence of hepatic injury in acute CO-poisoned patients. The secondary goals were to investigate the recovery trends of hepatic injury caused by acute CO poisoning and the relation to neurologic outcome and mortality. Results: Eight hundred ninety-four patients were enrolled in the final analysis, 128 cases (14.3%) had subclinical hepatic injury and 15 (1.6%) cases had hepatic injury. The relationship with mortality was not statistically significant. However, the hepatic injury group was higher incidence of intensive care unit admission and other complications. Patients in the hepatic injury group recovered through conservative management within 1 week of being admitted to the ED. Conclusions: While CO-induced hepatic injury is relatively uncommon, it can be associated with complications and poor neurologic outcome. However, CO-induced hepatic injury was not found to have a statistically significant effect on mortality rate.

The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children

“…In this study, no significant difference was found between the study groups in terms of pCO2 and COHb levels. The half-life of COHb is between 250 and 320 min while breathing room air, about 90 min while breathing high-flow oxygen, and 30 min while breathing 100% hyperbaric oxygen [ 23 ]. Most of the time, oxygen therapy and hydration for patients with CO poisoning are started on the road to hospital or at the event scene, before blood samples are taken, and before patients reach the hospital.…”

“…There is scarce evidence on hepatic injury due to CO poisoning. In their retrospective study with 894 adult patients, Kim et al reported that 1.6% of patients had hepatic injury and 14.3% had subclinical hepatitis-related injury [ 23 ]. In our study with 107 pediatric patients, hepatic damage was not detected in the group with and without myocardial damage.…”