Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning

• Published in: The American journal of emergency medicine Vol. 37; no. 5; pp. 823 - 827
• Main Authors: Jung, Jong Woo, Lee, Jun Ho
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019; Elsevier Limited
• Subjects: Acute Disease; Adolescent; Adult; Age; Aged; Aged, 80 and over; Aspartate aminotransferase; Biomarkers - blood; Blood; Calcium-binding protein; Carbon monoxide; Carbon monoxide poisoning; Carbon Monoxide Poisoning - blood; Coma; Consciousness; Creatinine; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Family medical history; Female; Glasgow Coma Scale; Humans; Hypoxia; Inhalation; Investigations; Laboratories; Lactic acid; Lactic Acid - blood; Male; Medical records; Middle Aged; Neurotoxicity; Neurotoxicity Syndromes - blood; Neurotoxicity Syndromes - diagnosis; Neurotoxicity Syndromes - etiology; Phosphopyruvate hydratase; Phosphopyruvate Hydratase - blood; Pneumonia; Poisoning; Retrospective Studies; Risk factors; Severity of Illness Index; Time Factors; Troponin; Variables; Young Adult; United States > US; Neurotoxicity; Poisoning; Carbon monoxide
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.07.046

This study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning. A total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6 months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome). A total of 432 patients (median age: 55 years, range: 17–91 years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894, respectively. Initial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients.