Use of carboxyhemoglobin as a biomarker of environmental CO exposure: critical evaluation of the literature

Agnese Veronesi*, Valentina Pecoraro, Stefano Zauli, Marta Ottone, Giovanni Leonardi, Paolo Lauriola, Tommaso Trenti

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


Carbon monoxide (CO) poisoning is the primary cause for access to emergency department (ED) services for more than 50,000 persons in Europe and the USA every year. CO poisoning diagnosis is based on multiple factors and is usually confirmed by high carboxyhemoglobin (COHb) levels in the blood. We conducted a systematic evaluation of literature to investigate the usefulness of COHb as a biomarker of environmental CO exposure. We conducted an electronic search in Medline, Embase, and the Cochrane Library databases. We selected studies reporting high or low environmental CO concentrations, as well as COHb levels in exposed subjects presenting in ED or staying at home. We included 19 studies, but only 7 studies reported environmental CO concentration and proved a correlation between COHb and CO exposure in healthy and non-smoker subjects only. However, confounding factors were often incompletely assessed. The main symptoms reported were headache, nausea, vertigo and vomiting. COHb data stored in healthcare databases were used in six studies and provided useful information about symptoms, CO sources and patient characteristics. Most studies were classified at risk of bias. This review indicates that COHb is the most commonly used biomarker to assess CO exposure and seems to be useful. Further studies are needed to establish the reliability of COHb as a biomarker and/or explore other possible biomarkers. Surveillance systems of the general population, correlated with geographical locations and other confounding factors, could be important for CO exposure monitoring and the development of focused prevention programs.

Original languageEnglish
Pages (from-to)25798-25809
Number of pages12
JournalEnvironmental Science and Pollution Research
Issue number33
Publication statusPublished - 1 Nov 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017, Springer-Verlag GmbH Germany.


  • Air monitoring
  • Biomarker
  • CO poisoning
  • Carbon monoxide
  • Carboxyhemoglobin


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