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

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 identify significant risk factors, hazard ratio (HR), and confidence intervals (CI). Results: The cumulative incidence was 12.0% and 19.7% for DNS and MI, respectively. A Glasgow Coma Scale (GCS) score of <9 (OR, 2.55; 95% CI, 1.52-4.27) and rhabdomyolysis (OR, 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 (OR, 2.50; 95% CI, 1.67-3.74), rhabdomyolysis (OR, 4.91; 95% CI, 3.28-7.35), acute renal impairment (OR, 2.43; 95% CI, 1.59-3.71), and leukocytosis (OR, 9.55; 95% CI, 3.88-23.50). Hyperbaric oxygen therapy for patients with COP was more beneficial for DNS (OR, 0.64; 95% CI, 0.34-1.20) than for MI (OR, 1.94; 95% CI, 0.94-4.01). Conclusion: Early differentiation of risk factors for DNS and MI contributes to an effective evaluation of patients with acute COP and the provision of appropriate therapy.