Lee Sang Hwan, Ryu Soo Rack, Yoo Kyung Hun, Lee Juncheol, Cho Yongil, Lim Tae Ho, Kang Hyunggoo, Oh Jaehoon, Ko Byuk Sung
Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea.
Am J Emerg Med. 2025 Mar;89:144-150. doi: 10.1016/j.ajem.2024.12.042. Epub 2024 Dec 19.
There is a paucity of research comparing the prognosis of patients with carbon monoxide (CO) poisoning only and CO poisoning with other toxic exposures. This study compared a group of patients with CO poisoning only and a group of patients with CO poisoning combined with other toxic exposures in terms of mortality and morbidity (ischemic stroke, venous thromboembolism (VTE), and myocardial infarction).
This study used claims data from the National Health Insurance Service in South Korea. Propensity score matching was used to balance covariates between the two groups and the Cox proportional-hazard model was used to calculate hazard ratios (HR).
Using 1:4 propensity score matching, data from 3240 patients with CO poisoning plus other toxic exposures, and 12,960 with CO poisoning only, diagnosed between 2005 and 2020, were analyzed. The median follow-up was 4.98 years for mortality in patients with CO poisoning only and 4.04 years for mortality in patients with CO poisoning plus other toxic exposures. In the overall period, the HR for mortality in patients with CO poisoning plus other toxic exposures compared to those with CO poisoning only was 1.16 (95 % confidence interval [CI] 1.05-1.27); for VTE, the HR was 1.31 (95 % CI 1.02-1.69). For the 30-day follow-up period, the HR for VTE was 1.66 (95 % CI 1.01-2.72), while in the target group after 30 days, the HR for mortality was 1.18 (95 % CI 1.06-1.32).
CO poisoning plus other toxic exposures was associated with a higher risk for long-term mortality and VTE compared with CO poisoning alone. Active screening for VTE in the acute stages of CO poisoning plus other toxic exposures and ongoing monitoring for the occurrence of long-term mortality are necessary.
比较单纯一氧化碳（CO）中毒患者与合并其他毒物暴露的CO中毒患者预后的研究较少。本研究比较了一组单纯CO中毒患者和一组合并其他毒物暴露的CO中毒患者在死亡率和发病率（缺血性卒中、静脉血栓栓塞症（VTE）和心肌梗死）方面的情况。
本研究使用了韩国国民健康保险服务的理赔数据。采用倾向得分匹配法平衡两组之间的协变量，并使用Cox比例风险模型计算风险比（HR）。
采用1:4倾向得分匹配法，分析了2005年至2020年间诊断的3240例合并其他毒物暴露的CO中毒患者和12960例单纯CO中毒患者的数据。单纯CO中毒患者死亡率的中位随访时间为4.98年，合并其他毒物暴露的CO中毒患者死亡率的中位随访时间为4.04年。在整个时间段内，合并其他毒物暴露的CO中毒患者与单纯CO中毒患者相比，死亡率的HR为1.16（95%置信区间[CI]1.05-1.27）；VTE的HR为1.31（95%CI 1.02-1.69）。在30天随访期内，VTE的HR为1.66（95%CI 1.01-2.72），而在30天后的目标组中，死亡率的HR为1.18（95%CI 1.06-1.32）。
与单纯CO中毒相比，合并其他毒物暴露的CO中毒与更高的长期死亡率和VTE风险相关。对合并其他毒物暴露的CO中毒急性期患者进行VTE的积极筛查以及对长期死亡率的发生进行持续监测是必要的。
