Kim June-Sung, Ko Byuk Sung, Sohn Chang Hwan, Kim Youn-Jung, Kim Won Young
Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05505, Korea.
Department of Emergency Medicine, University of Hanyang, College of Medicine, Seoul 04763, Korea.
Diagnostics (Basel). 2020 Apr 21;10(4):242. doi: 10.3390/diagnostics10040242.
Myocardial dysfunction due to acute carbon monoxide (CO) poisoning is common and associated with poor outcomes. The role of cardiac markers, including creatine kinase-myocardial band (CK-MB), high-sensitivity troponin I (hsTnI), and brain natriuretic peptide (BNP), in identifying patients with CO-induced cardiomyopathy were evaluated. This single-center, retrospective cohort study included 905 consecutive adult patients in the CO poisoning registry from February 2009 to December 2019. Cardiomyopathy was defined as any abnormality on transthoracic echocardiography (TTE), including left ventricular systolic and diastolic dysfunction, right ventricular dysfunction, and wall motion abnormalities. The areas under receiver operating curves (AUCs) for biomarkers were compared. Of the 850 included patients, 101 (11.9%) had CO-induced cardiomyopathy. Initial and peak hsTnI and CK-MB concentrations, and initial BNP concentrations were significantly higher in patients with than without cardiomyopathy (all P-values < 0.01), but the AUCs were higher for hsTnI (0.894) and CK-MB (0.864) than for BNP (0.796). Initial TnI > 0.01 ng/mL and CK-MB > 1.5 ng/mL each had 95% sensitivity and 97% negative predictive value for CO-induced cardiomyopathy. Higher hsTnI or CK-MB levels on admission can identify patients at high-risk of CO-induced cardiomyopathy and can be a screening tool for CO poisoning.
急性一氧化碳（CO）中毒所致心肌功能障碍很常见，且与不良预后相关。我们评估了包括肌酸激酶同工酶（CK-MB）、高敏肌钙蛋白I（hsTnI）和脑钠肽（BNP）在内的心脏标志物在识别CO中毒性心肌病患者中的作用。这项单中心回顾性队列研究纳入了2009年2月至2019年12月CO中毒登记处的905例连续成年患者。心肌病定义为经胸超声心动图（TTE）显示的任何异常，包括左心室收缩和舒张功能障碍、右心室功能障碍以及室壁运动异常。比较了生物标志物的受试者工作特征曲线下面积（AUC）。在纳入的850例患者中，101例（11.9%）患有CO中毒性心肌病。有心肌病的患者初始和峰值hsTnI及CK-MB浓度以及初始BNP浓度显著高于无心肌病的患者（所有P值<0.01），但hsTnI（0.894）和CK-MB（0.864）的AUC高于BNP（0.796）。初始TnI > 0.01 ng/mL和CK-MB > 1.5 ng/mL对CO中毒性心肌病的敏感性均为95%，阴性预测值均为97%。入院时较高的hsTnI或CK-MB水平可识别CO中毒性心肌病的高危患者，可作为CO中毒的筛查工具。
