Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.
Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey.
Clin Toxicol (Phila). 2020 Dec;58(12):1313-1319. doi: 10.1080/15563650.2020.1743302. Epub 2020 Mar 31.
The early identification of patients with a high risk of developing delayed neurological sequelae (DNS) can improve the quality of care in carbon monoxide (CO) poisoning cases. The aim of this study is to investigate whether the serum netrin-1 levels measured at presentation to the emergency department (ED) predicted the development of DNS after acute CO intoxication. This prospective observational study was conducted between 1 August 2018 and 31 July 2019 in a single tertiary hospital. The patients with acute CO intoxication and serum netrin-1 levels measured at the time of ED presentation were included in the study. All patients were followed up for six weeks regarding the development of DNS. The patients were divided into two groups, including those who developed DNS (DNS group) and those who did not (non-DNS group). A total of 183 patients were included in the study, and 54 (29.5%) developed DNS. The median serum netrin-1 level at ED presentation was significantly lower in the DNS group (391.5 pg/mL [263.0-550.5]) than in the non-DNS group (626.0 pg/mL [505.9-755.6]) ( < .001). Multivariate analysis revealed that a low serum netrin-1 level (adjusted odds ratio [AOR]: 8.02, 95% CI: 2.45-26.20), low Glasgow coma scale (GCS) score at ED presentation (AOR: 0.81, 95% CI: 0.68-0.97), long CO exposure time (AOR: 1.96, 95% CI: 1.49-2.56), and the presence of acute brain lesions (AOR: 8.24, 95% CI: 2.37-28.58) on diffusion-weighted imaging were independent predictors of DNS. Serum netrin-1 levels less than 432 pg/mL predicted the development of DNS with a sensitivity of 68.5% (95% CI: 54.4%-80.5%) and a specificity of 86.0% (95% CI: 78.8%-91.5%). Low serum netrin-1 levels were significantly associated with the development of DNS. Therefore, serum netrin-1 at ED presentation can help identify patients at risk of developing DNS following discharge.
一氧化碳中毒患者早期识别发生迟发性神经功能障碍（DNS）的高危人群有助于改善此类患者的医疗护理质量。本研究旨在探讨急诊（ED）就诊时血清神经导向因子-1（netrin-1）水平能否预测急性一氧化碳中毒后发生 DNS。这是一项于 2018 年 8 月 1 日至 2019 年 7 月 31 日在一家三甲医院进行的前瞻性观察性研究。纳入 ED 就诊时检测到急性一氧化碳中毒和血清 netrin-1 水平的患者。所有患者在 6 周内随访是否发生 DNS。根据是否发生 DNS 将患者分为 DNS 组和非 DNS 组。本研究共纳入 183 例患者，其中 54 例（29.5%）发生 DNS。DNS 组 ED 就诊时的中位血清 netrin-1 水平（391.5pg/ml [263.0-550.5]）明显低于非 DNS 组（626.0pg/ml [505.9-755.6]）（ <.001）。多变量分析显示，血清 netrin-1 水平低（调整后比值比[OR]：8.02，95%置信区间[CI]：2.45-26.20）、ED 就诊时格拉斯哥昏迷量表（GCS）评分低（OR：0.81，95% CI：0.68-0.97）、CO 暴露时间长（OR：1.96，95% CI：1.49-2.56）、弥散加权成像上存在急性脑损伤（OR：8.24，95% CI：2.37-28.58）是发生 DNS 的独立预测因素。血清 netrin-1 水平低于 432pg/ml 预测发生 DNS 的敏感性为 68.5%（95% CI：54.4%-80.5%），特异性为 86.0%（95% CI：78.8%-91.5%）。血清 netrin-1 水平低与 DNS 的发生显著相关。因此，ED 就诊时的血清 netrin-1 有助于识别出院后发生 DNS 的高危患者。
