Potential risk factors for delayed neurological sequelae and myocardial injury following acute carbon monoxide poisoning: A retrospective study

Min-Po Ho; Yuan-Hui Wu; Tsan-Chi Chen; Kuang-Chau Tsai; Chen-Chang Yang

doi:10.1097/JCMA.0000000000001208

Potential risk factors for delayed neurological sequelae and myocardial injury following acute carbon monoxide poisoning: A retrospective study

J Chin Med Assoc. 2025 Jan 16. doi: 10.1097/JCMA.0000000000001208. Online ahead of print.

Authors

Min-Po Ho¹, Yuan-Hui Wu^{1

2}, Tsan-Chi Chen³, Kuang-Chau Tsai¹, Chen-Chang Yang^{4

5

6}

Affiliations

¹ Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
² School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC.
³ Departments of Medical Research, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
⁴ School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC.
⁵ Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC.
⁶ Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

PMID: 39815402
DOI: 10.1097/JCMA.0000000000001208

Abstract

Background: Acute carbon monoxide poisoning (COP) has been a common cause of emergency hospital visits over the past decade. Besides the immediate symptoms of poisoning, carbon monoxide exposure can cause various long-term complications, especially delayed neurological sequelae (DNS) and myocardial injury (MI).

Methods: This study retrospectively enrolled 502 patients with COP, including complete collection data, from the Taiwan National Poison Control Center between January 1, 2000, and December 31, 2015. After collecting the relevant clinical and laboratory data, multivariate logistic regression analysis was performed to investigate the associations between potential predictors and risk factors, hazard ratio (HR), and confidence intervals (CI).

Results: The cumulative incidence rates were 12.0% and 19.7% for DNS and MI, respectively. A Glasgow Coma Scale (GCS) score of <9 (HR 2.55; 95% CI: 1.52-4.27) and rhabdomyolysis (HR 2.68; 95% CI: 1.59-4.53) were identified as individual indicators of DNS in patients with COP. However, a greater risk for MI was associated with a GCS score of <9 (HR 2.50; 95% CI: 1.67-3.74), rhabdomyolysis (HR 4.91; 95% CI: 3.28-7.35), acute renal impairment (HR 2.43; 95% CI: 1.59-3.71), and leukocytosis (HR 9.55; 95% CI: 3.88-23.50). Hyperbaric oxygen therapy for patients with COP was more beneficial for DNS (HR 0.64; 95% CI: 0.34-1.20) than for MI (HR 1.94; 95% CI: 0.94-4.01).

Conclusion: Early differentiation of risk factors between DNS and MI contributes to an effective evaluation of patients with acute COP and the provision of appropriate therapy.