Department of Biostatistics and Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
JAMA Netw Open. 2022 May 2;5(5):e2210552. doi: 10.1001/jamanetworkopen.2022.10552.
Preventing neurocognitive sequelae is a major goal of treating acute carbon monoxide (co) poisoning. There is a lack of reliable score systems exist for assessing the probability of these sequelae.
To develop and validate a novel clinical scoring system for predicting poor neurocognitive outcomes after acute co poisoning.
DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included derivation and validation cohorts based on consecutive patient data prospectively collected at university hospitals from January 2006 to July 2021 in Wonju, Republic of Korea, and from August 2016 to June 2020 in Incheon, Republic of Korea. Participants included individuals aged 16 years or older admitted with co poisoning. Data were analyzed from October 2021 to January 2022.
Clinical and laboratory variables.
The outcome of interest was neurocognitive sequelae at 4 weeks after co poisoning. Logistic regression models were used to identify predictors of poor neurocognitive outcomes in the derivation cohort. Outcomes were assessed using the Global Deterioration Scale [GDS] at 1-month after co exposure and classified as good (1-3 points) or poor (4-7 points).
A total of 1282 patients (median [IQR] age, 47.0 [35.0-59.0] years; 810 [63.2%] men) were assessed, including 1016 patients in the derivation cohort and 266 patients in the validation cohort. The derivation cohort included 126 patients (12.4%) with poor GDS scores. Among 879 patients in the derivation cohort with 1-year follow-up data, 757 (86.1%) had unchanged GDS scores, 102 (11.6%) had improved GDS scores, and 20 (2.3%) had worsened GDS scores. In the final prediction model, age older than 50 years (1 point), Glasgow Coma Scale score of 12 or less (1 point), shock (1 point), serum creatine kinase level greater than 320 U/L at emergency department presentation (1 point), and no use of hyperbaric oxygen therapy (1 point) remained factors significantly associated with worse outcome; therefore, this scoring system was called COGAS (creatine kinase, hyperbaric oxygen therapy, Glasgow Coma Scale, age, shock). Area under the receiver operating characteristic curve for COGAS score was 0.862 (95% CI, 0.828-0.895) for the derivation cohort and 0.870 (95% CI, 0.779-0.961) for the validation cohort.
These findings suggest that assessing the COGAS score during the early phase of co poisoning may help identify patients at risk of poor neurocognitive sequelae.
预防神经认知后遗症是治疗急性一氧化碳（CO）中毒的主要目标。目前缺乏可靠的评分系统来评估这些后遗症的发生概率。
开发和验证一种新的临床评分系统，用于预测急性 CO 中毒后不良神经认知结局。
设计、地点和参与者：这是一项预后研究，纳入了 2006 年 1 月至 2021 年 7 月在韩国沃朱市和 2016 年 8 月至 2020 年 6 月在韩国仁川市的两所大学医院前瞻性连续采集患者数据的推导队列和验证队列。参与者包括因 CO 中毒入院的年龄在 16 岁及以上的个体。数据分析于 2021 年 10 月至 2022 年 1 月进行。
临床和实验室变量。
感兴趣的结局是 CO 暴露后 4 周的神经认知后遗症。使用逻辑回归模型在推导队列中确定不良神经认知结局的预测因素。使用 CO 暴露后 1 个月的全球衰退量表（GDS）评估结局，并将其分为良好（1-3 分）或不良（4-7 分）。
共评估了 1282 例患者（中位数[IQR]年龄，47.0[35.0-59.0]岁；810[63.2%]为男性），包括推导队列中的 1016 例患者和验证队列中的 266 例患者。推导队列中有 126 例（12.4%）患者 GDS 评分较差。在推导队列中，有 879 例患者进行了为期 1 年的随访，其中 757 例（86.1%）GDS 评分无变化，102 例（11.6%）GDS 评分改善，20 例（2.3%）GDS 评分恶化。在最终预测模型中，年龄大于 50 岁（1 分）、格拉斯哥昏迷量表评分 12 分或以下（1 分）、休克（1 分）、急诊时肌酸激酶水平大于 320 U/L（1 分）和未使用高压氧治疗（1 分）仍然是与预后不良显著相关的因素；因此，该评分系统被命名为 COGAS（肌酸激酶、高压氧治疗、格拉斯哥昏迷量表、年龄、休克）。COGAS 评分的受试者工作特征曲线下面积在推导队列中为 0.862（95%CI，0.828-0.895），在验证队列中为 0.870（95%CI，0.779-0.961）。
这些发现表明，在 CO 中毒的早期阶段评估 COGAS 评分可能有助于识别有发生不良神经认知后遗症风险的患者。
