Background

Acute carbon monoxide (CO) poisoning is one of the most common poisons worldwide and neuropsychiatric sequelae (NS) are the most frequent form of its morbidity.

Objectives

This study aimed to measure the percentage of patients liable to NS, to evaluate the cognitive profile of patients with NS and to assess the role of neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) in predicting the development of NS after acute CO poisoning.

Methods

This prospective study included 50 patients with acute CO poisoning presented to the Poison Control Center, Ain Shams University Hospitals during the period from beginning of November 2015 till the end of January 2017. Patients’ demographic characteristics, clinical manifestations and blood carboxyhemoglobin levels were recorded. Serum levels of NSE and GFAP were determined on admission. Every patient was invited to participate in a follow-up visit at a dedicated outpatient clinic one month after CO exposure. During the visit, a complete neurological examination, as well as a psychiatric evaluation using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders version 4 Axis-I were performed for detection of neurological and psychiatric disorders. Wechsler memory scale test was administrated for detection of cognitive deficits. The patients were divided into two groups based on the presence or absence of NS.

Results

Cognitive impairment was found in 38 % of patients in the NS group. The serum levels of NSE and GFAP were significantly high in the NS group in comparison to the non-NS group. Receiver operating characteristic curves (ROC) determined the cut-off level of NSE at 39 ng/mL achieved 100 % sensitivity with 88.64 % specificity to predict the development of NS after acute CO poisoning while GFAP had 95.24 % sensitivity and 69.23 % specificity at a cut-off value of 2.8 ng/mL.

Conclusion

NSE and GFAP could be useful in the early identification of patients at risk of developing NS after CO poisoning helping in treatment plans and thus improving quality of care.

中文翻译：

---

急性一氧化碳中毒的神经精神后遗症：神经元特异性烯醇化酶和胶质纤维酸性蛋白的预测作用

背景

急性一氧化碳 (CO) 中毒是世界范围内最常见的毒物之一，神经精神后遗症 (NS) 是其最常见的发病形式。

目标

本研究旨在测量易患 NS 的患者百分比，评估 NS 患者的认知状况，并评估神经元特异性烯醇化酶 (NSE) 和胶质纤维酸性蛋白 (GFAP) 在预测急性后 NS 发展中的作用一氧化碳中毒。

方法

这项前瞻性研究包括 2015 年 11 月至 2017 年 1 月期间在艾因夏姆斯大学医院毒物控制中心就诊的 50 名急性 CO 中毒患者。记录患者的人口统计学特征、临床表现和血液碳氧血红蛋白水平。入院时测定血清 NSE 和 GFAP 水平。每位患者都被邀请在 CO 暴露一个月后参加专门门诊的随访。在访问期间，进行了完整的神经系统检查以及使用《精神疾病诊断和统计手册第 4 轴-I 结构化临床访谈》进行的精神评估，以检测神经系统和精神疾病。Wechsler 记忆量表测试用于检测认知缺陷。根据有无 NS 将患者分为两组。

结果

NS 组 38% 的患者出现认知障碍。与非 NS 组相比，NS 组的血清 NSE 和 GFAP 水平显着升高。接受者操作特征曲线 (ROC) 确定 NSE 在 39 ng/mL 的截止水平达到 100% 的敏感性和 88.64% 的特异性，以预测急性 CO 中毒后 NS 的发展，而 GFAP 的敏感性为 95.24%，特异性为 69.23%截止值为 2.8 ng/mL。

结论

NSE 和 GFAP 可用于早期识别 CO 中毒后有发生 NS 风险的患者，有助于制定治疗计划，从而提高护理质量。