Objective

A major challenge for physicians is to identify patients with acute carbon monoxide (CO) poisoning who are likely to develop delayed neuropsychiatric sequelae (DNS). DNS is defined as neuropsychological sequelae that develops after 2–40 days of lucid interval after CO intoxication. Currently, there is no consensus on factors that predict the prognosis of CO poisoning. Thus, the purpose of this study was to identify factors predicting the development of DNS using a Cox regression model.

Methods

This prospective observational study included 310 CO-poisoned patients admitted to an emergency department in South Korea from July 2017 to February 2020. Demographic, clinical, and laboratory data were analyzed. Kaplan–Meier curves were constructed to estimate the cumulative incidence of DNS. A multivariate Cox regression model was used to identify the main predictors of the development of DNS.

Results

The incidence of DNS was 18.8 %, and the median onset time was 23.7 days (interquartile range, 14–30 days). The Kaplan–Meier survival curve showed that a serum creatine kinase (CK) level > 175.5 U/L and initial Glasgow Coma Scale (GCS) score ≤ 9 were associated with a higher cumulative incidence of DNS (log-rank test; p < 0.01 and p = 0.02, respectively). Cox regression analysis showed that a serum CK level > 175.5 U/L (hazard ratio [HR]: 2.862, 95 % confidence interval [CI]: 1.491–5.496; p < 0.01) and an initial GCS ≤ 9 (HR: 2.081, 95 % CI: 1.048–4.131; p = 0.04) were significant prognostic factors.

Conclusion

In acute CO poisoning, an initial GCS score ≤ 9 and serum CK level > 175.5 U/L are significant predictors of DNS development.

中文翻译：

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急性一氧化碳中毒迟发性神经精神后遗症预后因素的Cox回归模型：一项前瞻性观察研究

客观的

医生面临的一个主要挑战是识别可能出现迟发性神经精神后遗症 (DNS) 的急性一氧化碳 (CO) 中毒患者。DNS 被定义为在 CO 中毒后 2-40 天的清醒间隔后出现的神经心理后遗症。目前，对于预测 CO 中毒预后的因素尚未达成共识。因此，本研究的目的是使用 Cox 回归模型确定预测 DNS 发展的因素。

方法

这项前瞻性观察性研究纳入了 2017 年 7 月至 2020 年 2 月在韩国急诊科就诊的 310 名一氧化碳中毒患者。对人口统计学、临床和实验室数据进行了分析。构建 Kaplan-Meier 曲线以估计 DNS 的累积发生率。使用多元 Cox 回归模型来确定 DNS 发展的主要预测因素。

结果

DNS 的发生率为 18.8%，中位发病时间为 23.7 天（四分位距，14-30 天）。Kaplan-Meier 生存曲线显示血清肌酸激酶 (CK) 水平 > 175.5 U/L 和初始格拉斯哥昏迷量表 (GCS) 评分 ≤ 9 与较高的 DNS 累积发生率相关（对数秩检验；p < 0.01和 p = 0.02，分别）。Cox 回归分析显示血清 CK 水平 > 175.5 U/L（风险比 [HR]：2.862，95% 置信区间 [CI]：1.491–5.496；p < 0.01）和初始 GCS ≤ 9（HR：2.081， 95 % CI：1.048–4.131；p = 0.04）是重要的预后因素。

结论

在急性 CO 中毒中，初始 GCS 评分 ≤ 9 和血清 CK 水平 > 175.5 U/L 是 DNS 发展的重要预测因素。