Abstract
Carbon monoxide poisoning (CO) is a major public health problem. Brain is the most sensitive organ to hypoxia induced by CO poisoning. Delayed Neurological Sequelae (DNS) is considered to be a delayed onset of neuropsychiatric symptoms after apparent recovery from acute CO poisoning. Therefore, this study was aimed to make a prospective comparative study between three markers (serum glutathione reductase, S100b protein and serum neurone- specific enolase) to predict the occurrence of DNS. This study was performed on 57 adult patients with acute CO poisoning. The markers were measured after arrival and the patients were divided into two groups: the DNS group (8 patients) & the non –DNS group (49 patients). There was a statistical difference between the two groups in terms of significant increase in loss of consciousness, syncope, dizziness, ECG changes, pneumonia, carboxyhemoglobin level, creatine phosphokinase, creatine phosphokinase-MB, troponin I, S100b protein, neurone-specific enolase in DNS grouped patiens and significant decrease in glasgow coma scale and glutathione reductase in DNS group. The cut off value of glutathione reductase was ≤ 30 U/L with a percentage of accuracy 94. 74. The cut off value of S100b protein was > 18.94 Pg/ L with 98.25 % percentage of accuracy, while, the cut off value of neurone-specific enolase was > 30.49 ng/ml and its accuracy was 96.49 %. All these cut off values predicted the occurrence of DNS. SO, it is concluded that serum S100b protein may represent the most reliable chemical marker for the prediction of DNS after acute CO poisoning by logistic regression analysis.
Highlights
Carbon monoxide (CO) poisoning is a major public health problem worldwide & considered to be one of the most common causes of death in the world
The affinity of hemoglobin for CO is 250 times higher than that for oxygen, the result is the formation of carboxy hemoglobin (CO-Hb) which is a molecule incapable of carrying O2 to tissue sites resulting in tissue hypoxia (Suner and Jay, 2008)
Delayed Neurological Sequelae (DNS): delayed neurological sequelae, GCS: Glasgow coma scale, Continuous data presented as median and IQR while categorical data presented as number and percentage, Mann Whitney test for quantitative data between the two groups
Summary
Carbon monoxide (CO) poisoning is a major public health problem worldwide & considered to be one of the most common causes of death in the world. Many studies were done to detect reliable plasma biomarkers that could be of a great value in the prediction of the development of DNS such as Plasma copeptin, nitrix oxide, serum s100b protein, serum Tau protein, carboxy hemoglobin level (Co-Hb), white blood cells (WBC) count, creatine phosphokinase (CPK), creatine kinase- MB (CK-MB) and others (Pang et al, 2013) This present study was aimed to assess the usefulness of serum 100b protein, neuron specific enolase (NSE) and glutathione reductase (GSH) as biomarkers for the prediction of DNS in CO poisoned patients and compare the accuracy, sensitivity and specificity of them to detect the best one by logistic regression analysis. The results of comparison between GSH, S100b protein and NSE by Z- statistics test to determine the best predictable value for the occurrence of DNS in table (9) revealed that there was not a significant clear difference in AUC between them which means that there is no superiority of one to the others. If we need to depend on one of them to predict DNS, we will use multiple stepwise logistic regression analysis test that showed that the use of only one model which was S100b protein model
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