Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan

Mau-Sheng Lin; Chun-Chi Lin; Chen-Chang Yang; Shu-Chuan Weng; Shun-Mu Wang; Chuan-Yu Chen; Nicole Huang; Yuan-Hwa Chou

doi:10.1016/j.jcma.2017.12.006

Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan

J Chin Med Assoc. 2018 Aug;81(8):682-690. doi: 10.1016/j.jcma.2017.12.006. Epub 2018 May 28.

Authors

Mau-Sheng Lin¹, Chun-Chi Lin², Chen-Chang Yang³, Shu-Chuan Weng⁴, Shun-Mu Wang⁵, Chuan-Yu Chen⁶, Nicole Huang⁷, Yuan-Hwa Chou⁸

Affiliations

¹ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Emergency Medicine, Dajia Lees General Hospital, Lees Medical Corporation, Taichung, Taiwan, ROC; Department of Emergency Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
² Division of General Medicine, Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC; Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
³ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: ccyang@vghtpe.gov.tw.
⁴ Bachelor's Degree Program of Golden-Age Well-being Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC.
⁵ Department of Public Health, China Medical University, Taichung, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC.
⁶ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC; National Health Research Institutes, Miaoli, Taiwan, ROC.
⁷ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, ROC.
⁸ Section of Community Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Psychiatry, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.

PMID: 29853349
DOI: 10.1016/j.jcma.2017.12.006

Abstract

Background: Carbon monoxide (CO) poisoning has recently become a serious health problem in some Asian countries, including Taiwan. The aims of this study are to evaluate the changing trend of CO poisoning and to demonstrate the association between myocardial injury and neurological sequelae of CO poisoning in Taiwan between 1990 and 2011.

Methods: This retrospective cohort study included all eligible patients with acute CO poisoning reported to the Taiwan National Poison Control Center during the study period. The changing trend of CO poisoning and its impacts on the primary outcomes, i.e., persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS), were then assessed.

Results: 786 CO poisoned cases were reported. Among them, 467 cases were intentional. Intentional CO exposure started to become the major cause of CO poisoning in Taiwan in 2002. Increase in the number of intentional CO poisoning significantly correlated with the increase in the overall number of CO poisoning (r = 0.972, p < 0.001). Patients who took tranquilizer (OR = 3.89; 95% CI:1.94-7.77), had myocardial injury (OR = 1.70; 95% CI:1.03-2.82), had been stayed in intensive care unit (OR = 2.03; 95% CI:1.13-3.62), presented with GCS less than 9 (OR = 4.05; 95% CI:2.32-7.08) and had abnormal brain image (OR = 14.46; 95% CI:5.83-35.83) had a higher risk of PNS. Moreover, patients who were older age (OR = 1.04; 95% CI:1.02-1.07), had psychiatric disorder history (OR = 2.82; 95% CI:1.35-5.89), had myocardial injury (OR = 1.33; 95% CI:1.16-1.53), and presented with GCS less than 9 (OR = 3.23; 95% CI:1.65-6.34) had a higher risk of DNS.

Conclusion: The pattern of CO poisoning had changed markedly during the study period, with a significant increase in both the numbers of intentional and overall CO poisoning. Moreover, intentional CO poisoning was associated with a higher risk of neurological sequelae, which was mediated by various indicators of poisoning severity such as myocardial injury and GCS less than 9.

Keywords: Acute CO poisoning; Charcoal-burning; Delayed neurological sequelae; Persistent neurological sequelae.

MeSH terms

Acute Disease
Adult
Carbon Monoxide Poisoning / complications*
Cardiomyopathies / etiology*
Female
Humans
Hyperbaric Oxygenation
Male
Middle Aged
Nervous System Diseases / etiology*
Peripheral Nervous System Diseases / etiology
Retrospective Studies