Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Am J Emerg Med. 2021 May;43:195-199. doi: 10.1016/j.ajem.2020.02.054. Epub 2020 Feb 25.
The primary goal of treating patients with carbon monoxide (CO) poisoning is preventing delayed neuropsychiatric sequelae (DNS). It is difficult to predict DNS because there is no precise diagnostic method in the early phase of CO poisoning. In this study, we aimed to investigate the optimal cut-off value for creatine kinase level to predict DNS.
This retrospective observational study included patients with CO poisoning visiting a single tertiary center from January to July 2018. They were divided into two groups according to the presence of DNS. We compared baseline characteristics with variables that could affect the presence of DNS. The optimal cut-off value of initial creatine kinase concentration for DNS was calculated. Additionally, multivariate analysis was performed to confirm whether creatine kinase could be an independent predictor of DNS.
Of the 138 patients, 12 patients developed DNS. Univariate analysis showed significant differences in the Glasgow Coma Scale, duration of exposure, laboratory tests, abnormal finding on MRI in acute phase, the number of hyperbaric oxygen therapy sessions, and duration of hospitalization. Receiver operating characteristic analyses of creatine kinase were performed (AUC = 0.92; 95% CI, 0.86-0.96) with a cut-off value of 1603 U/L; DNS was predicted with a sensitivity of 91.7% and specificity of 88.1%. In multivariate analysis, the adjusted odds ratio of creatine kinase was 51.516.
In patients with CO poisoning, initial creatine kinase concentrations of >1603 U/L can be used as an independent predictor of DNS.
治疗一氧化碳（CO）中毒患者的主要目标是预防迟发性神经精神后遗症（DNS）。由于在 CO 中毒的早期阶段没有精确的诊断方法，因此很难预测 DNS。在这项研究中，我们旨在研究肌酸激酶水平的最佳截断值以预测 DNS。
本回顾性观察性研究纳入了 2018 年 1 月至 7 月间在一家三级医院就诊的 CO 中毒患者。根据是否存在 DNS，将他们分为两组。我们比较了基线特征与可能影响 DNS 存在的变量。计算了初始肌酸激酶浓度对 DNS 的最佳截断值。此外，还进行了多变量分析以确认肌酸激酶是否为 DNS 的独立预测因子。
在 138 例患者中，有 12 例发生了 DNS。单变量分析显示格拉斯哥昏迷量表、暴露时间、实验室检查、急性期 MRI 异常发现、高压氧治疗次数和住院时间存在显著差异。对肌酸激酶进行了接收器工作特征分析（AUC=0.92；95%CI，0.86-0.96），截断值为 1603 U/L；DNS 的预测敏感性为 91.7%，特异性为 88.1%。在多变量分析中，肌酸激酶的调整后优势比为 51.516。
在 CO 中毒患者中，初始肌酸激酶浓度>1603 U/L 可作为 DNS 的独立预测因子。
