Karbon monoksit zehirlenmesinde geç dönem nöro-psikozun öngörülmesinde yeni bir yöntem: Karboksihemoglobin / Troponin, Karboksihemoglobin / Nötrofil ve Karboksihemoglobin/ Lenfosit
Öz
Amaç: Carbonmonoksit
zehirlenmesi (CO) dünyadaki en sık zehirleme ve ölüm nedenlerinden
biridir. CO zehirlenmesi,
carboksihemoglobin (COHb), troponin (cTn), nötrofil ve lenfosit ile bunların
oranları olan COHb/ cTn oranı (COTR), COHb/nötrofil oranı (CONR) ve
COHb/lenfosit oranı (COLR)’nın nöro-psikoz (NP) ve mortalite açısından
etkilerinin değerlendirilmesi amaçlanmıştır.
Yöntem: Bu
kesitsel kohort çalışmasına, Ocak 2005- Aralık 2008 tarihleri arasında
hastanemiz acil servisine (ED) CO zehirlenmesi nedeniyle başvuran 1229 hasta
dahil edildi. Hastalar NP gruba göre; NP pozitif (NP+) ve NP negatif (NP-)
olarak iki gruba ayrıldı. COHb, cTn, nötrofil, lenfosit, COTR, CONR, COLR, yaş,
cinsiyet, kan şekeri, NP ve mortalite oranları açısından karşılaştırıldı.
Bulgular: Hastaların NP(-) grubunda
466(%40,9) erkek, 673(%59,1) kadındı ve NP(+) grubta 22(%24,4) erkek,
68(%75,6) kadındı (p<0.05). Red cell distrubition width(RDW), Mean Platelate
Volum(MPV), Neutrophil, lymphocyte, COHb, Troponin, COTR, CONR ve COLR düzeyleri NP(+) grubunda
yüksekti (p<0.05). NP değişkenler açısından cinsisyet ve mortalite açısından
anlamlıydı (p<0.05). Cinsiyetin NP ve mortalite ile diğer değişkenler
arasındaki analizi istatistiksel olarak anlamlı tespit edildi (p<0.05).
COTR, CONR ve COLR spearman analizinde istatistiksel olarak anlamlıydı
(p<0.05). Ayrıca COTR, CONR, COLR’ın NP ve mortalite ROC curve analizinde
duyarlılık ve özgüllük değerleri anlamlı bulundu.
Sonuç: CO
zehirlenmesinde COTR, CONR ve COLR düzeylerinin yüksek olması zehirlenme anında
ve sonrası gelişen komplikasyonlar, NP ve mortalite açısından prediktif
yardımcı bir değer olabilir.
Anahtar Kelimeler
Carbon monoxide poisoning emergency department COTR CONR COLR neuro-psychosis
Kaynakça
- References1.Gültekin M, İsmailoğulları SM, Mirza M, Ersoy AÖ. Neuropsychiatric Symptoms After Carbon Monoxide Intoxication. Journal of Parkinson's Disease and Movement Disorders. 2012;15(1):12-16.2.Kandiş H, Katırcı Y, Karapolat BS. Carbon Monoxide Poisoning. Journal of Düzce University Faculty of Medicine. 2009; 11(3):54-603.Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998;339:1603-8.4.Weaver LK. Carbon monoxide poisoning. N Engl J Med 2009;360:1217-25.5.Kurel B. Carbonmonoxide intoxication and hyperbaric oxygen treatment: report of three cases. Journal of Child Health and Diseases. 2005;48:164-7.6.Choi IS. Delayed neurologic sequel in carbon monoxide intoxication. Arc Neurol. 1983;40:422-5.7.Bayes-Genis A, Conover CA, Overgaard MT, et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. N Engl J Med. 2001;345(14):1022-9.8.Gendrel D, Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dic J 2000;19:679-88.9.Maisner M. Procalcitonin-a new, innovative infection parameter biochemical andclinical aspects. 3. revised and expanded edition. (Thieme, Stuttgart, New York), 2000. https://books.google.com.tr/books?isbn=3131055030 10.Braunwald E, Antman EM, Beasley JW, et al. American College of Cardiology; American Heart Association. Committee on the Management of Patients With Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366-74.11.Balta S, Demirkol S,Cakar M, et al. Other inflammatory markers should not be forgotten when assessing the neutrophil-to-lymphocyte ratio. Clin Appl Thromb Hemost 2013;19(6):693-4.12.Sahin DY, Elbasan Z, Gur M, et al. Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction. Angiology 2013;64(6):423-9.13.Nunez J, Nunez E, Bodi V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long- term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101(6):747-52.14.Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45(10):1638-43.15.Piantidosi CA, Schmechel DE, Zhang J. Is neuronal degeneration mediated by apoptosis after carbon monoxide poisoning. Undersea and Hyperbaric Medicine 1995;22:15-6.16.Tomaszewski C. Carbon monoxide poisoning. Early awareness and intervention can save lives. Postgrad Med 1999;105:39-50.17.Choi SI, Cheon HY. Delayed movement disorders after carbon monoxide poisoning. Eur Neurol 1999; 42:141-4.18.Scott BL, Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology 1996;46:68-74.19.Ceballos-Baumann AO, Passingham RE, Marsden CD, et al. Motor reorganization in acquired hemidystonia. Ann Neurol 1995;37:746-57.20.Tunç T, Çavdar L, Okuyucu E, İnan LE. Parkinsonism After Carbon Monoxide Intoxication. Journal of Parkinson's Disease and Movement Disorders. 2008;11(2): 29-32.21.Türkmen N, Akgöz S. Deaths due to carbon monoxide poisoning in autopsy in Bursa. Forensic Medicine Journal, 2005;19(2): 20-25.22. Azmak D, Çetin G, Kolusayın Ö, Soysal Z. Deaths due to carbon monoxide poisoning. Forensic Medicine Journal,1994;10:73-8123.Hosseininejad SM, Aminiahidashti H, Khatir IG et al. Carbon monoxide poisoning in Iran during 1999–2016: A systematic review and meta-analysis. J of Forensic and Legal Med 53 (2018) 87–9624.Ruth-Sahd LA, Zulkosky K, Fetter ME. Carbon monoxide poisoning: case studies and review. Dimens Crit Care Nurs 2011;30(6):303-14.25.Thom SR. Leukocytes in carbon monoxide-mediated brain oxidative injury. Toxicol Appl Pharmacol 1993;123(2):234-47.26.Ischiropoulos H, Beers MF, Ohnishi ST, et al. Nitric oxide production and perivascular tyrosine nitration in brain following carbon monoxide poisoning in the rat. J Clin Invest 1996;97(10):2260-7.27.Thom SR, Fisher D, Manevich Y. Roles for platelet-activating factor and NO-derivedoxidants causing neutrophil adherence after CO poisoning. Am J Physiol Heart Circ Physiol 2001; 281(2): 923-30.28.Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. 1990;97(2):491-4. 29.Felner JM, Churchwell AL, Murphy DA. Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol. 1984;4(5):1041-51. 30.Satran D, Henry CR, Adkinson C, et al. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005; 45(9):1513-6. 31.Aslan S, Erol MK, Karcioglu O, et al. The investigation of ischemic myocardial damage in patients with carbon monoxide poisoning. Anatolian Cardiology J. 2005;5(3):189-93.32.Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010; 105(2):186-91.33. Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/ lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl) 2010;123(23):3438-43.34.Kaya MG, Akpek M, Elcik D, et al. Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers. Am J Cardiol 2012;109(6):851-5.35.Thom SR, Bhopale VM, Han ST, et al. Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med 2006;174(11): 1239-48.36.Karabacak M, Turkdogan KA, Coskun A, et al. Detection of neutrophil-lymphocyte ratio as a serum marker associated with inflammations by acute carbon monoxide poisoning. J Acute Dis 2015;4(4):300-237.Koylu R, Cander B, Dundar ZD, et al. The Im¬portance of H-FABP in Determining the Severity of Carbon Mon¬oxide Poisoning. J Clin Med Res. 2011;3(6):296–30238.Gualandro DM, Puelacher C, Mueller C. High-sensitivity cardiac troponin in acute conditions. Curr Opin Crit Care. 2014;20(5):472–7 39.Lippi G, Rastelli G, Meschi T, et al. Pathophysiol¬ogy, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem. 2012;45(16-17):1278–85. 40.Roderique JD, Josef CS, Feldman MJ, Spiess BD. A modern lit¬erature review of carbon monoxide poisoning theories, thera¬pies, and potential targets for therapy advancement. Toxicol¬ogy. 2015;334:45–58.
A new method in foreseeing late-period neuro-psychosis in carbon monoxide poisoning: COHb/Troponin, COHb/Neutrophil, and COHb/ Lymphocyte
Öz
Objective: Carbon monoxide(CO) poisoning is one of the most
common reasons of poisoning and death in the world. Evaluation for the effects
of CO poisoning, carboxyhaemoglobin(COHb), troponin(cTn), neutrophil,
lymphocyte and their rates-which are COHb/cTn rate(COTR), COHb/neutrophil
rate(CONR), COHb/lymphocyte rate(COLR) in terms of Neuro-Psychosis(NP) and
mortality is aimed.
Method: 1229 patients who consulted our hospital’s Emergency
Department(ED) from January 2005 to December 2008, due to CO poisoning were
included in this sectional cohort study. The patients were divided into two
groups, NP positive(NP+) and NP negative(NP-), according to their NP groups. They were compared in terms of COHb, cTn,
neutrophil, lymphocyte, COTR, CONR, COLR, age, gender, NP, and mortality rates.
Results: 466(%40,9) members of the group NP(-) were males and
the other 673(%59,1) members were females. Therewithal, 22(%24,4) members of
the group NP(+) were males and the other 68(%75,6) members were females. Red
Cell Distribution Width(RDW), Mean Platelet Volume(MPV), neutrophil,
lymphocyte, COHb, troponin, COTR, CONR and COLR levels were high in group
NP(+). NP was significant in terms of gender and mortality values. The analysis
of gender between NP, mortality and the other variables was statistically
significant. COTR, CONR, and COLR were statistically significant in Spearman
analysis. Sensitivity and specificity values of COTR, CONR, COLR in NP and
mortality ROC curve analysis were also found to be significant.
Conclusions: The high levels of COTR, CONR, and COLR at CO
poisoning may be predictive and supportive values in terms of 'complications
during and after poisoning', NP and mortality.
Anahtar Kelimeler
Carbon monoxide poisoning emergency department neuropsychosis
Kaynakça
- References1.Gültekin M, İsmailoğulları SM, Mirza M, Ersoy AÖ. Neuropsychiatric Symptoms After Carbon Monoxide Intoxication. Journal of Parkinson's Disease and Movement Disorders. 2012;15(1):12-16.2.Kandiş H, Katırcı Y, Karapolat BS. Carbon Monoxide Poisoning. Journal of Düzce University Faculty of Medicine. 2009; 11(3):54-603.Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998;339:1603-8.4.Weaver LK. Carbon monoxide poisoning. N Engl J Med 2009;360:1217-25.5.Kurel B. Carbonmonoxide intoxication and hyperbaric oxygen treatment: report of three cases. Journal of Child Health and Diseases. 2005;48:164-7.6.Choi IS. Delayed neurologic sequel in carbon monoxide intoxication. Arc Neurol. 1983;40:422-5.7.Bayes-Genis A, Conover CA, Overgaard MT, et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. N Engl J Med. 2001;345(14):1022-9.8.Gendrel D, Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dic J 2000;19:679-88.9.Maisner M. Procalcitonin-a new, innovative infection parameter biochemical andclinical aspects. 3. revised and expanded edition. (Thieme, Stuttgart, New York), 2000. https://books.google.com.tr/books?isbn=3131055030 10.Braunwald E, Antman EM, Beasley JW, et al. American College of Cardiology; American Heart Association. Committee on the Management of Patients With Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366-74.11.Balta S, Demirkol S,Cakar M, et al. Other inflammatory markers should not be forgotten when assessing the neutrophil-to-lymphocyte ratio. Clin Appl Thromb Hemost 2013;19(6):693-4.12.Sahin DY, Elbasan Z, Gur M, et al. Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction. Angiology 2013;64(6):423-9.13.Nunez J, Nunez E, Bodi V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long- term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101(6):747-52.14.Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45(10):1638-43.15.Piantidosi CA, Schmechel DE, Zhang J. Is neuronal degeneration mediated by apoptosis after carbon monoxide poisoning. Undersea and Hyperbaric Medicine 1995;22:15-6.16.Tomaszewski C. Carbon monoxide poisoning. Early awareness and intervention can save lives. Postgrad Med 1999;105:39-50.17.Choi SI, Cheon HY. Delayed movement disorders after carbon monoxide poisoning. Eur Neurol 1999; 42:141-4.18.Scott BL, Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology 1996;46:68-74.19.Ceballos-Baumann AO, Passingham RE, Marsden CD, et al. Motor reorganization in acquired hemidystonia. Ann Neurol 1995;37:746-57.20.Tunç T, Çavdar L, Okuyucu E, İnan LE. Parkinsonism After Carbon Monoxide Intoxication. Journal of Parkinson's Disease and Movement Disorders. 2008;11(2): 29-32.21.Türkmen N, Akgöz S. Deaths due to carbon monoxide poisoning in autopsy in Bursa. Forensic Medicine Journal, 2005;19(2): 20-25.22. Azmak D, Çetin G, Kolusayın Ö, Soysal Z. Deaths due to carbon monoxide poisoning. Forensic Medicine Journal,1994;10:73-8123.Hosseininejad SM, Aminiahidashti H, Khatir IG et al. Carbon monoxide poisoning in Iran during 1999–2016: A systematic review and meta-analysis. J of Forensic and Legal Med 53 (2018) 87–9624.Ruth-Sahd LA, Zulkosky K, Fetter ME. Carbon monoxide poisoning: case studies and review. Dimens Crit Care Nurs 2011;30(6):303-14.25.Thom SR. Leukocytes in carbon monoxide-mediated brain oxidative injury. Toxicol Appl Pharmacol 1993;123(2):234-47.26.Ischiropoulos H, Beers MF, Ohnishi ST, et al. Nitric oxide production and perivascular tyrosine nitration in brain following carbon monoxide poisoning in the rat. J Clin Invest 1996;97(10):2260-7.27.Thom SR, Fisher D, Manevich Y. Roles for platelet-activating factor and NO-derivedoxidants causing neutrophil adherence after CO poisoning. Am J Physiol Heart Circ Physiol 2001; 281(2): 923-30.28.Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. 1990;97(2):491-4. 29.Felner JM, Churchwell AL, Murphy DA. Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol. 1984;4(5):1041-51. 30.Satran D, Henry CR, Adkinson C, et al. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005; 45(9):1513-6. 31.Aslan S, Erol MK, Karcioglu O, et al. The investigation of ischemic myocardial damage in patients with carbon monoxide poisoning. Anatolian Cardiology J. 2005;5(3):189-93.32.Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010; 105(2):186-91.33. Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/ lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl) 2010;123(23):3438-43.34.Kaya MG, Akpek M, Elcik D, et al. Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers. Am J Cardiol 2012;109(6):851-5.35.Thom SR, Bhopale VM, Han ST, et al. Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med 2006;174(11): 1239-48.36.Karabacak M, Turkdogan KA, Coskun A, et al. Detection of neutrophil-lymphocyte ratio as a serum marker associated with inflammations by acute carbon monoxide poisoning. J Acute Dis 2015;4(4):300-237.Koylu R, Cander B, Dundar ZD, et al. The Im¬portance of H-FABP in Determining the Severity of Carbon Mon¬oxide Poisoning. J Clin Med Res. 2011;3(6):296–30238.Gualandro DM, Puelacher C, Mueller C. High-sensitivity cardiac troponin in acute conditions. Curr Opin Crit Care. 2014;20(5):472–7 39.Lippi G, Rastelli G, Meschi T, et al. Pathophysiol¬ogy, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem. 2012;45(16-17):1278–85. 40.Roderique JD, Josef CS, Feldman MJ, Spiess BD. A modern lit¬erature review of carbon monoxide poisoning theories, thera¬pies, and potential targets for therapy advancement. Toxicol¬ogy. 2015;334:45–58.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2019 |
| Kabul Tarihi | 19 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 41 Sayı: 1 |