Poison severity score and sequential organ failure assessment score: Carbon monoxide poisoning prognosis.

Il Jae Wang,Ji-Ho Ryu,Seong-Youn Hwang,Soon-Chang Park,Sang-Kyoon Han,Sung-Hwa Lee,Sung-Wook Park,Seok-Ran Yeom,Chiara Lazzeri

doi:10.1371/journal.pone.0212025

Abstract

PurposeWe aimed to examine the utility of the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) score as early prognostic predictors of short-term outcomes in patients with carbon monoxide (CO) poisoning. We hypothesized that both the PSS and the SOFA score would be useful prognostic tools.MethodsThis was retrospective observational study of patients with CO poisoning who presented to the emergency department and were admitted for more than 24 hours. We calculated PSS, the initial SOFA score, a second (2nd) SOFA score, and a 24-hour delta SOFA score. The primary outcome was reported as the cerebral performance category (CPC) scale score at discharge. We classified those with CPC 1–2 as the good outcome group and those with CPC 3–5 as the poor outcome group.ResultsThis study included 192 patients: 174 (90.6%) belonged to the good outcome group, whereas 18 (9.4%) belonged to the poor outcome group. The PSS (1.00 [0.00, 1.00] vs 3.00 [3.00, 3.00], p < 0.001), initial SOFA (1.00 [0.00, 2.00] vs 4.00 [3.25, 6.00], p < 0.001), 2nd SOFA score (0.00 [0.00, 1.00] vs 4.00 [3.00, 7.00], p < 0.001), and 24-hour delta SOFA score (-1.00 [-1.00, 0.00] vs 0.00 [-1.00, 1.00], p = 0.047) of the good outcome group were significantly higher than those of the poor outcome group. The areas under the receiver operating characteristic curve for PSS and the initial SOFA and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944–0.993), 0.945 (95% CI 0.903–0.973), and 0.978 (95% CI 0.947–0.994), respectively.ConclusionThe PSS, initial SOFA score, and 2nd SOFA score predict acute poor outcome accurately in patients with CO poisoning.

Highlights

Carbon monoxide (CO) is produced during incomplete combustion of carbon containing compounds; it is a colorless, odorless, tasteless, non-irritant gas [1]
The areas under the receiver operating characteristic curve for Poison Severity Score (PSS) and the initial Sequential Organ Failure Assessment (SOFA) and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944– 0.993), 0.945, and 0.978, respectively
We investigated the accuracy of PSS and serial SOFA scores for predicting acute poor outcomes in patients with CO poisoning

Summary

Introduction

Carbon monoxide (CO) is produced during incomplete combustion of carbon containing compounds; it is a colorless, odorless, tasteless, non-irritant gas [1]. CO exists in a very low concentration (less than 0.001%) in the atmosphere, and a small amount exists naturally in the human body [2, 3]. Exposure of an individual to high concentrations of CO can be fatal [4]. CO toxicity is estimated to account for more than half of the fatal poisonings in many countries [5]. It has a high prevalence rate globally, and in the United States, more than 50,000 patients visit emergency departments annually because of CO poisoning [6, 7]. In Korea, unintentional CO poisoning is decreasing, but the rate of suicide by CO poisoning is steadily increasing, and it is the fourth most common suicide method [8]

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