Risk factors for delayed encephalopathy following carbon monoxide poisoning: Importance of the period of inability to walk in the acute stage

Abstract

Objective Delayed neurological sequelae (DNS) is a serious complication that occurs after acute carbon monoxide (CO) intoxication. The study identified factors for predicting DNS development for the purpose of improving CO intoxication treatment strategies. Methods The medical records of 65 patients admitted to Shizuoka Saiseikai General Hospital between 2004 and 2020 due to CO poisoning were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed, using a range of evaluated items as explanatory variables and the development of DNS as the response variable. Results Patients who developed DNS were found to have higher peak creatine kinase (CK) (odds ratio, 1.0003; 95% CI, 1.0001–1.0005; P<0.001), and experienced a greater number of days during which walking was impossible in the acute stage following intoxication (odds ratio, 1.011; 95% CI, 1.005–1.018; P<0.001) according to the univariate analysis. Multivariate analyses indicated that DNS development was related to the score, peak CK (U/L) + 40 × the number of days in which walking was impossible. The model demonstrated an area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.91–1.00), and DNS was predicted with 100% sensitivity and 82% specificity. Conclusion An indicator that incorporates the number of days that walking is impossible for a patient could be useful in planning therapeutic strategies.

Magnetic resonance imaging for predicting delayed neurologic sequelae caused by carbon monoxide poisoning: A systematic review and meta-analysis

“…To date, most investigations that used MRI have been focused on either diffusion-weighted imaging [ 14 – 16 , 18 ] or diffusion tensor imaging [ 17 , 26 ] as the sites of typical lesions after CO poisoning. However, pathological changes in the acute phase were too small to observe conventional MRI and diffusion-weighted imaging or diffusion tensor imaging in most patients.…”

“…With regard to patient selection, 4 (66.7%) patients were at a high or unclear risk of bias because they did not specify patient selection methodology (random or consecutive). [14,[17][18][19] With regard to index text, 5 (83.3%) were at an unclear risk of bias with regard to the index text during blinding or not during sample analysis. [14,15,[17][18][19] With regard to patient flow and time domains, 1 (66.7%) patients was at a high risk of bias, as not all selected patients received MRI.…”

“…After the title, abstract, and full text were reviewed, 38 publications did not focus on MRI for predicting DNS and 14 had no unavailable data. Finally, 6 studies [14][15][16][17][18][19] were included according to the study inclusion and exclusion criteria.…”

“…All the studies were performed in Asia. Of these studies, 4 used diffusion-weighted imaging, [14][15][16]18] 1 used diffusion tensor imaging, [17] and 1 used diffusion kurtosis imaging. [19] The mean sample size of the studies was 106, ranging from 52 to 183.…”

Predictive Value of Gray-Matter–White-Matter Ratio on Brain Computed Tomography for Delayed Encephalopathy after Acute Carbon Monoxide Poisoning: A Retrospective Cohort Study

“…These reports were subsequently confirmed by the medical institution. Regular examination using a standardized cognitive test was not routinely utilized [ 18 ].…”