A combination of <scp>NLR</scp> and <scp>sST2</scp> is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

Liu, Qian; Gao, Xun; Xiao, Qingmian; Zhu, Baoyue; Liu, Yongjian; Han, Yongyan; Wang, Weizhan

doi:10.1002/clc.23550

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…44 Decreased lymphocyte count implies a decline in immune regulation and an increase in stress. 45 Taken together, the above facts strongly supported the premise, suggesting that a higher ULR may serve as a better risk stratification tool for HS.…”

Section: Discussionsupporting

confidence: 57%

“…An inflammatory stress may also be generated when SUA enters cells due to the impact of intracellular SUA on the generation of reactive oxygen species to the reactive nitrogen species and the Cox‐2 activation 44 . Decreased lymphocyte count implies a decline in immune regulation and an increase in stress 45 . Taken together, the above facts strongly supported the premise, suggesting that a higher ULR may serve as a better risk stratification tool for HS.…”

Section: Discussionmentioning

confidence: 61%

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Association of serum uric acid to lymphocyte ratio, a novel inflammatory biomarker, with risk of stroke: A prospective cohort study

et al. 2023

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Main Problem Inflammation plays an important role in the pathological progress associated with stroke. Serum uric acid (SUA) to lymphocyte ratio (ULR), a novel inflammatory biomarker, has been considered as a better risk stratification tool of adverse outcomes than SUA or lymphocyte alone. This study aimed to investigate whether ULR produced more predictive value for stroke and explore the potential mediators of the associations. Methods This study enrolled 93,023 Chinese participants without stroke and myocardial infarction at baseline. Cox proportional hazard models were used to analyze the associations of ULR with stroke and subtypes. Mediation analyses were conducted to explore potential mediators of the associations. Results During a median follow‐up of 13.00 years, 6081 cases of incident stroke occurred, including 5048 cases of ischemic stroke (IS) and 900 cases of hemorrhagic stroke (HS). After adjustment for confounders, the Q4 group was associated with a higher risk of HS (HR, 1.25; 95% CI, 1.03–1.50), but not with total stroke (HR, 1.07; 95% CI, 1.03–1.13) or IS (HR, 1.04; 95% CI, 0.97–1.12). No significant associations were found between SUA or lymphocyte and any stroke. ULR outperformed SUA or lymphocytes alone in predicting stroke. Additionally, the significant association between ULR and HS was partially mediated by systolic blood pressure (20.32%), diastolic blood pressure (11.18%) and estimated glomerular filtration rate (9.19%). Conclusions ULR was significantly associated with the risk of HS, but not with IS. Systolic blood pressure, diastolic blood pressure and estimated glomerular filtration rate were potential mediators for the association.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 61%

Association of serum uric acid to lymphocyte ratio, a novel inflammatory biomarker, with risk of stroke: A prospective cohort study

et al. 2023

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“…Our STEMI group had no increase in troponin levels. Although troponin, especially high sensitivity troponin, is a key marker of myocardial injury, it cannot be used to predict cardiovascular events in the context of moderate to severe CO poisoning [ 21 ]. These changes may be transient and determined by direct CO toxicity, as opposed to atherosclerotic mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Rare Causes of Acute Coronary Syndrome: Carbon Monoxide Poisoning

Haliga

Morărașu

Șorodoc

et al. 2022

Life

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Acute coronary syndrome (ACS) is a spectrum of clinical and paraclinical disorders arising from an imbalance of oxygen demand and supply to the myocardium. The most common cause is atherosclerosis; however, other rare causes such as carbon monoxide (CO) poisoning should be considered. Through tissue hypoxia and direct cell injury, CO poisoning can lead to a broad spectrum of cardiac disorders, especially ACS. Materials and Methods. We have conducted a retrospective study in the Toxicology Department of Saint Spiridon Emergency University Hospital, including all patients admitted through the emergency department with CO poisoning. We divided the cohort into event group (myocardial injury) and non-event group (patients without myocardial injury) and performed a subset analysis of the former. Results. A total of 65 patients were included, 22 in the event and 43 in the non-event group. The severity of poisoning did not correlate with myocardial injury; however, 50% of the event group had severe poisoning with carboxyhaemoglobin ≥ 20%. Cardiac enzyme markers (troponin and creatin-kinase MB) had a statistically significant increase in the event group compared to the non-event group (p < 0.05). Most of the patients in the STEMI (50%) and NSTEMI (66.7%) groups had severe CO intoxication. The STEMI group had a mean age of 27.7 years old and no comorbidities. Conclusions. Myocardial injury can develop in CO poisoning irrespective of the severity of poisoning, and it can be transient, reversible, or permanent. Our study introduces new information on adverse cardiac events in patients with CO poisoning, focusing on the ACS. We found that the severity of CO poisoning plays an important role in developing myocardial injury, as 50% of patients in the event group were severely intoxicated. While in-hospital mortality in our study was low, further prospective studies should investigate the long-term mortality in these patients.

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A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

Liu

Gao

Xiao

et al. 2021

Clinical Cardiology

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Background Indicators of adverse cardiovascular events in patients with acute carbon monoxide (CO) poisoning‐induced myocardial injury have not yet been elucidated. Hypothesis This study aimed at determining the risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Methods We enrolled patients with moderate‐to‐severe acute CO poisoning‐induced myocardial injury. Based on the occurrence of adverse cardiovascular events, the patients were assigned into event and non‐event group. Binary logistic regression analysis was performed to analyze the potential risk factors for cardiovascular adverse events. Results A total of 413 eligible patients were enrolled. Among them, 61 (14.8%) patients presented adverse cardiovascular events and were assigned to the event group while 352 patients were assigned to the non‐event group. Univariate analysis revealed that cTnI, Lac, and NLR levels at admission and sST2 at day 3 in the event group were significantly higher compared to those in the non‐event group. Subsequent multivariate analysis revealed that sST2 at day 3 and NLR at admission were independent risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Finally, the sensitivity, specificity, and AUC of sST2 at day 3 combined with NLR for event prediction were 79.5%, 82.8%, and 0.858, respectively. Conclusion A combination of sST2 at day 3 and NLR is a potential predictor for the occurrence of adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Therefore, cardiovascular risk stratification should be taken into consideration, especially in patients with acute CO poisoning‐induced myocardial injury.

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A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

Cited by 4 publications

References 20 publications

Association of serum uric acid to lymphocyte ratio, a novel inflammatory biomarker, with risk of stroke: A prospective cohort study

Association of serum uric acid to lymphocyte ratio, a novel inflammatory biomarker, with risk of stroke: A prospective cohort study

Rare Causes of Acute Coronary Syndrome: Carbon Monoxide Poisoning

A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

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