Prognostic factors of carbon monoxide poisoning in Taiwan: A retrospective observational study

Ke Ting Pan; Chih Hao Shen; Fu Gong Lin; Yu Ching Chou; Ben Croxford; Giovanni Leonardi; Kun Lun Huang

doi:10.1136/bmjopen-2019-031135

Prognostic factors of carbon monoxide poisoning in Taiwan: A retrospective observational study

Ke Ting Pan, Chih Hao Shen, Fu Gong Lin, Yu Ching Chou, Ben Croxford, Giovanni Leonardi, Kun Lun Huang^*

^*Corresponding author for this work

HP: Chemicals & Environmental Effects

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Objectives To identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital. Design Retrospective observational study. Setting Tri-Service General Hospital, Taiwan. Methods We conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ 2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes. Results The logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes. Conclusion We identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.

Original language	English
Article number	e031135
Journal	BMJ Open
Volume	9
Issue number	11
DOIs	https://doi.org/10.1136/bmjopen-2019-031135
Publication status	Published - 1 Nov 2019

Bibliographical note

Funding Information:
In summary, in the present study, we tried to find the factors related to the poor prognosis of CO poisoning. The factors best at predicting outcomes were a high GCS score, high BUN and more intubation days. Even HBO therapy is paid by insurance in Taiwan, the benefit of repetitive HBO therapy on the treatment outcome remains to be elucidated. Our results in this retrospective study could give the indications for clinical research work in the future. The authors would like to thank Dr Kao Li-Ting from National Defence Medical Centre for providing assistance in reviewing the manuscript and all the clinical staffs in Hyperbaric Oxygen Centre in Tri-Service General Hospital for their kind hospitality and for granting access to their medical records. Contributors K-TP, C-HS and K-LH are responsible for the conception and design of the study. K-TP and C-HS collected data. K-TP, F-GL, Y-CC and K-LH analysed and interpreted data. K-TP and K-LH drafted the manuscript. K-TP, C-HS, BC, GL and K-LH discussed and approved the final version of the manuscript. Funding The study was funded by Tri-Service General Hospital. Competing interests None declared. Patient consent for publication Not required. Ethics approval This study was approved by the Institutional Review Board of the Tri-Service General Hospital (TSGHIRB Approval No. 2-101-05-034). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available.

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

carbon monoxide poisoning
hyperbaric oxygen therapy
internal medicine

Access to Document

10.1136/bmjopen-2019-031135

Cite this

@article{787bded421f0417b9ba804a1eb954774,

title = "Prognostic factors of carbon monoxide poisoning in Taiwan: A retrospective observational study",

abstract = "Objectives To identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital. Design Retrospective observational study. Setting Tri-Service General Hospital, Taiwan. Methods We conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ 2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes. Results The logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes. Conclusion We identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.",

keywords = "carbon monoxide poisoning, hyperbaric oxygen therapy, internal medicine",

author = "Pan, {Ke Ting} and Shen, {Chih Hao} and Lin, {Fu Gong} and Chou, {Yu Ching} and Ben Croxford and Giovanni Leonardi and Huang, {Kun Lun}",

note = "Funding Information: In summary, in the present study, we tried to find the factors related to the poor prognosis of CO poisoning. The factors best at predicting outcomes were a high GCS score, high BUN and more intubation days. Even HBO therapy is paid by insurance in Taiwan, the benefit of repetitive HBO therapy on the treatment outcome remains to be elucidated. Our results in this retrospective study could give the indications for clinical research work in the future. The authors would like to thank Dr Kao Li-Ting from National Defence Medical Centre for providing assistance in reviewing the manuscript and all the clinical staffs in Hyperbaric Oxygen Centre in Tri-Service General Hospital for their kind hospitality and for granting access to their medical records. Contributors K-TP, C-HS and K-LH are responsible for the conception and design of the study. K-TP and C-HS collected data. K-TP, F-GL, Y-CC and K-LH analysed and interpreted data. K-TP and K-LH drafted the manuscript. K-TP, C-HS, BC, GL and K-LH discussed and approved the final version of the manuscript. Funding The study was funded by Tri-Service General Hospital. Competing interests None declared. Patient consent for publication Not required. Ethics approval This study was approved by the Institutional Review Board of the Tri-Service General Hospital (TSGHIRB Approval No. 2-101-05-034). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2019",

month = nov,

day = "1",

doi = "10.1136/bmjopen-2019-031135",

language = "English",

volume = "9",

journal = "BMJ Open",

issn = "2044-6055",

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TY - JOUR

T1 - Prognostic factors of carbon monoxide poisoning in Taiwan

T2 - A retrospective observational study

AU - Pan, Ke Ting

AU - Shen, Chih Hao

AU - Lin, Fu Gong

AU - Chou, Yu Ching

AU - Croxford, Ben

AU - Leonardi, Giovanni

AU - Huang, Kun Lun

N1 - Funding Information: In summary, in the present study, we tried to find the factors related to the poor prognosis of CO poisoning. The factors best at predicting outcomes were a high GCS score, high BUN and more intubation days. Even HBO therapy is paid by insurance in Taiwan, the benefit of repetitive HBO therapy on the treatment outcome remains to be elucidated. Our results in this retrospective study could give the indications for clinical research work in the future. The authors would like to thank Dr Kao Li-Ting from National Defence Medical Centre for providing assistance in reviewing the manuscript and all the clinical staffs in Hyperbaric Oxygen Centre in Tri-Service General Hospital for their kind hospitality and for granting access to their medical records. Contributors K-TP, C-HS and K-LH are responsible for the conception and design of the study. K-TP and C-HS collected data. K-TP, F-GL, Y-CC and K-LH analysed and interpreted data. K-TP and K-LH drafted the manuscript. K-TP, C-HS, BC, GL and K-LH discussed and approved the final version of the manuscript. Funding The study was funded by Tri-Service General Hospital. Competing interests None declared. Patient consent for publication Not required. Ethics approval This study was approved by the Institutional Review Board of the Tri-Service General Hospital (TSGHIRB Approval No. 2-101-05-034). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Publisher Copyright: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objectives To identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital. Design Retrospective observational study. Setting Tri-Service General Hospital, Taiwan. Methods We conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ 2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes. Results The logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes. Conclusion We identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.

AB - Objectives To identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital. Design Retrospective observational study. Setting Tri-Service General Hospital, Taiwan. Methods We conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ 2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes. Results The logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes. Conclusion We identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.

KW - carbon monoxide poisoning

KW - hyperbaric oxygen therapy

KW - internal medicine

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SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

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M1 - e031135

ER -

Prognostic factors of carbon monoxide poisoning in Taiwan: A retrospective observational study

Abstract

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