Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan

Lin, Mau Sheng; Lin, Chun Chi; Yang, Chen Chang; Weng, Shu Chuan; Wang, Shun Mu; Chen, Chuan Yu; Huang, Nicole; Chou, Yuan Hwa

doi:10.1016/j.jcma.2017.12.006

Cited by 22 publications

(18 citation statements)

References 37 publications

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“…PNSs are a direct result of hypoxic brain damage, which is defined as the neurological symptoms evident at presentation that persist through hospitalization. DNSs manifest as a relapse of neurological deficits after lucid intervals, with an incidence ranging from 3% to 40% . Although the method for assessing the neurological state and the source and severity of CO poisoning varies among studies, neurological sequelae after CO poisoning are, at least in part, reversible .…”

Section: Introductionmentioning

confidence: 99%

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

Moon

Chun

Cho

2018

Basic Clin Pharma Tox

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Growing evidence indicates that inflammation is associated with neurological sequelae after CO poisoning. Several scores incorporating the peripheral complete blood cell (CBC) count have been introduced as indicators of systemic inflammation. This study investigated whether these scores can improve the predictive accuracy for long-term neurological outcome of acute carbon monoxide (CO) poisoning. Two hundred seventy-nine patients who suffered from acute CO poisoning were included. Data on the demographic details, serial peripheral CBC counts and scores based on peripheral CBC counts (neutrophil-lymphocyte ratio (NLR), monocytelymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index [SII]) over the first 12 hours after presentation together with the clinical course during hospitalization and long-term neurological outcome were collected. Both a multivariate logistic regression model with only significant univariate predictors and a model with univariate predictors plus each score for long-term neurological outcome were constructed. Patients with a poor long-term neurological outcome had higher neutrophil and monocyte counts and lower lymphocyte counts over the first 12 hours after admission than patients with a good outcome. The diagnostic performance of the NLR, MLR and SII over the first 12 hours for predicting long-term neurological outcome was acceptable. These scores at presentation were independently associated with the long-term neurological outcome. Among these scores, only the SII at presentation significantly improved the predictive accuracy of the model when combined with clinical parameters (AUC 0.949, 95% CI 0.916-0.972 vs AUC 0.923, 95% CI 0.884-0.952 for the model with clinical parameters only, P = 0.0476). The optimal cut-off value for SII at presentation was 1012.2, resulting in a sensitivity of 97% (84.2%-99.9%) and specificity of 64.6% (58.2%-70.6%). The SII at presentation could significantly improve the prognostic accuracy for predicting the long-term neurological outcome in patients with acute CO poisoning. Because the SII is an inexpensive and easily measurable parameter, it might be used as a prognostic tool in clinical fields. K E Y W O R D S

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Section: Introductionmentioning

confidence: 99%

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

Moon

Chun

Cho

2018

Basic Clin Pharma Tox

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“…Mild ACOP symptoms include dizziness, headache, and limb weakness. Long-term exposure to CO can lead to central nervous system and cardiovascular system injury and even death ( 10 , 11 ). ACOP has become one of the most common types of poisoning causing death in the world ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiac injury after acute carbon monoxide poisoning and its clinical treatment scheme

Geng

Hao

et al. 2020

Exp Ther Med

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This study was designed to investigate cardiac injury after acute carbon monoxide poisoning and its clinical treatment scheme. Seventy patients with moderate and severe acute carbon monoxide poisoning (ACOP) admitted from January 2017 to December 2018 into The Affiliated Hospital of Qingdao University were regarded as a research group (RG), and another 30 healthy adults undergoing physical examination in the hospital during the same period were selected as a control group (CG). Thirty-five patients in the RG who received hyperbaric oxygen therapy were considered as group A, and 35 patients who received extracorporeal membrane oxygenation therapy were considered as group B. The effective rates and complications of the two groups after treatment were compared. The concentrations of creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) of myocardial enzymes at different time points before and after treatment were detected. Expression of miR-30a in the blood of experimental subjects was detected by time-fluorescence quantitative PCR, and the relationship between miR-30a expression and ACOP patients was analyzed. Patients in groups A and B achieved obvious efficacy, but the effective rate and incidence rate of complications in the extracorporeal membrane oxygenation (ECMO) group were better than those in the hyperbaric oxygen group. The concentrations of CK-MB and LDH in group A and group B were significantly higher than those in control group (P<0.01). The expression level of miR-30a in the RG was significantly higher than that in the control group (P<0.05). Both hyperbaric oxygen therapy and ECMO therapy have obvious efficacy on ACOP patients, but the latter is better than the former. The expression level of miR-30a in blood of ACOP patients increased significantly, which is positively correlated with myocardial injury, and it decreased after treatment. It is believed that miR-30a can provide a reference index for early diagnosis and prediction of disease progression and prognosis in cardiac injury of ACOP.

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“…The following variables, which have been suggested as prognostic factors in CO poisoning and can be easily evaluated at ED presentation, were tested in the univariate analysis: age, initial glasgow outcome scale (GCS), intentional exposure to CO, arterial HCO 3 − , white blood cell (WBC) count, and C-reactive protein (CRP), creatinine and troponin I levels. 17 A multivariate binary logistic regression model (model 1) was established using significant univariate variables. Plasma NGAL, confounding factors for plasma NGAL, and significant univariate variables were entered into a second multivariate logistic regression model (model 2).…”

Section: Methodsmentioning

confidence: 99%

Predictive value of plasma neutrophil gelatinase-associated lipocalin in acute charcoal-burning carbon monoxide poisoning

Moon

Chun

et al. 2019

Hum Exp Toxicol

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This study aimed to assess the feasibility of using the plasma neutrophil gelatinase-associated lipocalin (NGAL) level at the time of presentation in the emergency department (ED) to predict acute kidney injury (AKI) and the long-term neurological outcomes of acute charcoal-burning carbon monoxide (CO) poisoning. This retrospective study included 260 patients who suffered acute charcoal-burning CO poisoning. The median plasma NGAL concentration at the time of presentation in the ED after acute charcoal-burning CO poisoning was 78 (54–115) ng/ml. The NGAL level was an independent predictor of AKI development and could be used to stratify the severity of AKI. However, the area under the receiver operating characteristic curve (AUC) of the predictive model for AKI that included both the plasma NGAL level and clinical parameters was comparable to that of the predictive model including only the clinical parameters. The plasma NGAL level at the time of presentation in the ED was an independent factor predicting long-term neurological outcomes in patients who did not develop AKI. In these patients, the plasma NGAL level significantly improved the predictive accuracy of the model when used in combination with clinical parameters. In contrast, the plasma NGAL level was not associated with long-term neurological outcomes in patients who developed AKI. Measurement of the plasma NGAL level at the time ED presentation might improve the prediction of long-term neurological outcomes in patients who do not develop AKI after acute charcoal-burning CO poisoning. However, it might not offer additional benefit for AKI prediction compared to previously used markers.

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Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan

Cited by 22 publications

References 37 publications

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

Cardiac injury after acute carbon monoxide poisoning and its clinical treatment scheme

Predictive value of plasma neutrophil gelatinase-associated lipocalin in acute charcoal-burning carbon monoxide poisoning

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