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

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.