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Abd El-Azim MM, Mousa MK, Abdelmaaboud RM, Rezq NN, Mohammed SS. Evaluation of the role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) time series as predictors of diagnosis and prognosis of hemotoxic snakebite. Biomarkers 2023; 28:652-662. [PMID: 37902066 DOI: 10.1080/1354750x.2023.2277668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND This study aimed to assess the predictive value of NLR, PLR, and MPV time series for diagnosis and prognosis of hemotoxic snakebite envenomation. METHODS This is a prospective study among snakebite patients admitted to the Poison Control Center of Ain Shams University Hospitals and Assiut University Hospitals from the beginning of July 2019 to the end of October 2021. Patients were classified according to their clinical severity into three groups: mild, moderate, and severe. RESULTS The maximum incidence of snakebite was found in males (95%) from rural areas (80%); at lower limbs (70%); at night (51%); and during the autumn season (43.3%). The admission NLR and PLR can predict hemotoxic snakebite envenomation with an AUC of 0.940 and 0.569. The combination of NLR with PLR can develop a more predominant prediction of snakebite envenomation with an area under the curve (AUC) of 0.979. Furthermore, higher admission NLR and PLR levels are associated with prolonged hospital stays. CONCLUSION While NLR and PLR levels may be helpful in the diagnosis of snakebite, MPV plays no part in the prognosis of snakebite patients. Serial NLR, PLR initially, at 24 hours, and predischarge can be used to evaluate the early treatment response.
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Affiliation(s)
- Mariam M Abd El-Azim
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mona K Mousa
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ragaa M Abdelmaaboud
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nabil N Rezq
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarah S Mohammed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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İpek S, Güllü UU, Güngör Ş, Demiray Ş. The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children. Ir J Med Sci 2023; 192:2457-2466. [PMID: 36445626 PMCID: PMC9707252 DOI: 10.1007/s11845-022-03232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
AIMS In this study, cardiac biomarkers, blood parameters, electrocardiography (ECG), and echocardiography were investigated in children with carbon monoxide (CO) poisoning, and the diagnostic value of these parameters was investigated. METHODS The demographical, clinical, and laboratory data of children aged 0-18 years who were admitted to the pediatric emergency department due to CO poisoning between January 2019 and January 2022 were retrospectively scanned from medical records. The patients were divided into two groups as troponin-I positive and troponin-I negative. RESULTS There were 107 children aged 0-18 years (average age, 10.46 ± 5.77 years; 51% female) with CO poisoning. There were 13 patients with troponin-I positive myocardial injury. Troponin-I was positive in 3 patients whose carboxyhemoglobin (COHb) level was below 2% at the time of admission. In one patient, troponin-I, which was normal at admission, increased by the 24th hour of hospitalization. Hyperbaric oxygen therapy was given due to headache in one patient, although the COHb level of that patient was below 25%. An NT-proBNP level of ≥ 219.5 ng/L predicted the development of troponin-I positivity with a sensitivity of 70% and a specificity of 86.7% (AUC, 0.967 (0.58-0.994); p = 0.017). White blood cell (WBC), neutrophil, neutrophil-to-lymphocyte ratio (NLR), immature granulocyte (IG), and IG% levels were found to be significantly higher in the troponin-positive patient group. DISCUSSION AND CONCLUSION: NT-proBNP has been shown to be an early diagnostic marker for myocardial dysfunction. Additionally, when cardiac markers are not available, full blood parameters may assist clinicians for patient treatment and referral.
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Affiliation(s)
- Sevcan İpek
- Department of Pediatrics, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey
| | - Ufuk Utku Güllü
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey
| | - Şükrü Güngör
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey
| | - Şeyma Demiray
- Department of Pediatrics, Kahramanmaraş Sutcu Imam University Medical Faculty, Kahramanmaraş, Turkey
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DUYAN M, VURAL N. Diagnostic value of systemic immune-inflammation index and red cell distribution width-lymphocyte ratio in predicting troponin elevation in carbon monoxide poisoning. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1171643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: The aim of our study was to assess the significant value of the systemic inflammatory index (SII) and red cell distribution width/lymphocyte ratio (RLR) in patients with carbon monoxide poisoning (COP).
Materials and Methods: Based on a retrospective cross-sectional study design, this study was conducted among patients 18 years and older who presented to the hospital's emergency department with COP. The patients were separated into troponin positive and negative groups as an outcome of serial troponin measurements. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value of neutrophil/lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), RLR, and SII to predict troponin positivity.
Results: This study included 195 patients with CO exposure, 50 of whom had positive troponin tests. It was discovered that the diagnostic power of NLR, RLR, MLR, and SII was acceptable for identifying troponin positivity (AUC: 0.71-0.77). According to ROC curve comparisons, there was no diagnostic difference between these inflammatory biomarkers. Increased NLR, RLR, MLR, and SII were found to be independent predictors of troponin positivity after CO exposure (Odds ratio respectively: 8.65, 4.31, 7.24, 6.31).
Conclusion: SII and RLR, which are simple, inexpensive, and easily accessible parameters, are valuable in predicting troponin positivity in COP cases.
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Affiliation(s)
- Murat DUYAN
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nafis VURAL
- Department of Emergency Medicine, Ereğli State Hospital
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The Relationship of Blood Parameters with the Severity of Carbon Monoxide Poisoning. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1078003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Biomarkers of Inflammation and Inflammation-Related Indexes upon Emergency Department Admission Are Predictive for the Risk of Intensive Care Unit Hospitalization and Mortality in Acute Poisoning: A 6-Year Prospective Observational Study. DISEASE MARKERS 2021; 2021:4696156. [PMID: 34457088 PMCID: PMC8390135 DOI: 10.1155/2021/4696156] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
Patients poisoned with drugs and nonpharmaceutical substances are frequently admitted from the emergency department (ED) to a medical or ICU department. We hypothesized that biomarkers of inflammation and inflammation-related indexes based on the complete blood cell (CBC) count can identify acutely poisoned patients at increased risk for ICU hospitalization and death. We performed a 6-year prospective cohort study on 1548 adult patients. The demographic data, the levels of hs-CRP (high-sensitivity C-reactive protein), CBC, and inflammation-related indexes based on CBC counts were collected upon admission and compared between survivors and nonsurvivors, based on the poison involved. Both a multivariate logistic regression model with only significant univariate predictors and a model including univariate predictors plus each log-transformed inflammation-related indexes for mortality were constructed. The importance of the variables for mortality was graphically represented using the nomogram. hs-CRP (odds ratio (OR), 1.38; 95% CI, 1.16–1.65, p < 0.001 for log-transformed hs-CRP), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly associated with the risk of ICU hospitalization, after multivariable adjustment. Only RDW, NLR, and monocyte-lymphocyte ratio (MLR) were significantly associated with mortality. The predictive accuracy for mortality of the models which included either NLR (AUC 0.917, 95% CI 0.886-0.948) or MLR (AUC 0.916, 95% CI 0.884-0.948) showed a high ability for prognostic detection. The use of hs-CRP, RDW, NLR, and MLR upon ED admission are promising screening tools for predicting the outcomes of patients acutely intoxicated with undifferentiated poisons.
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Gao H, Sun L, Wu H, Chen J, Cheng Y, Zhang Y. The predictive value of neutrophil-lymphocyte ratio at presentation for delayed neurological sequelae in carbon monoxide poisoning. Inhal Toxicol 2021; 33:121-127. [PMID: 33596767 DOI: 10.1080/08958378.2021.1887410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the predictive value of neutrophil-lymphocyte ratio (NLR) at presentation for delayed neurological sequelae (DNS) in carbon monoxide (CO) poisoning. METHODS This single-center retrospective observational study included a total of 253 consecutive patients who visited the emergency department (ED) due to acute CO intoxication between 7 October 2015 and 31 December 2019. The included patients had a history of coma and their blood routine was measured within one hour of ED admission. They were divided into two groups according to the presence of DNS, including those who developed DNS (DNS group) and those who did not (non-DNS group). RESULTS A total of 171 patients were included in this research, and 49 (28.7%) developed DNS. The median NLR at ED admission was obviously higher in the DNS group (10.60 [9.69-15.34]) than in the non-DNS group (7.53 [5.86-8.56]) (p < 0.001). Multivariate analysis indicated that a high NLR (adjusted odds ratio (AOR): 1.78, 95% confidence interval (CI): 1.46-2.18) and the occurrence of acute brain lesions (AOR: 7.50, 95%CI: 2.86-19.68) on diffusion-weighted imaging were independent predictors of DNS. The NLR was more than 8.97. The prediction of occurrence of DNS had a sensitivity of 93.88% and a specificity of 84.43%. Kappa value was 0.713. The predicted results showed good authenticity and consistency. CONCLUSION The level of NLR at presentation had good predictive value for the development of DNS, showing the superior value for clinical application.
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Affiliation(s)
- Hongyu Gao
- Department of Emergency Medicine, College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Lixia Sun
- Department of Emergency Medicine, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Haiying Wu
- Department of Emergency Medicine, Tangshan Gongren Hospital, Tangshan, China
| | - Jinling Chen
- Department of Emergency Medicine, Tangshan Gongren Hospital, Tangshan, China
| | - Ying Cheng
- Department of Emergency Medicine, Tangshan Gongren Hospital, Tangshan, China
| | - Yuanyue Zhang
- Department of Emergency Medicine, Tangshan Gongren Hospital, Tangshan, China
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Myocardial Repolarization Parameters and Neutrophil-to-Lymphocyte Ratio are Associated with Cardiotoxicity in Carbon Monoxide Poisoning. Cardiovasc Toxicol 2020; 20:190-196. [PMID: 31863276 DOI: 10.1007/s12012-019-09560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The present study aims to examine the clinical values of complete blood count (CBC) bioindicators and corrected QT (QTc), Tpeak - Tend interval (Tp-e), Tpeak dispersion (Tp disp), and Tp-e/QT ratio that are the parameters of myocardial repolarization (M-rep) for cardiotoxicity, which develops due to acute carbon monoxide (CO) intoxication in patients admitted to the emergency service. This retrospective, cross-sectional, observational, and single-center study was conducted between April and June 2019. Statistical analysis was performed using the SPSS 23.0 software. Data of 234 participants were analyzed. Of these, 54.9% (n = 129) were female. Neutrophil-to-lymphocyte ratio (NLR), QTc, Tp-e values were significantly high in the CO intoxication group (p < 0.001, p < 0.001, and p < 0.001, respectively), whereas Tp-e/QTc ratio was significantly lower in the CO intoxication group than that in the control group (p < 0.001). NLR, Tp-e, Tp disp values were significantly high in the myocardial injury (M-inj) group (p < 0.001, p = 0.003, and p = 0.018, respectively). Furthermore, Tp-e/QTc ratio was significantly low in the M-inj group (p = 0.002). M-rep parameters and NLR are associated with CO intoxication and the development of M-inj. Moreover, these bioindicators and can provide clinicians an early indication of M-inj.
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Derangement of PaCO 2 requires physician attention in acute carbon monoxide poisoning. Hum Exp Toxicol 2020; 39:642-652. [DOI: 10.1177/0960327119898720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective was to describe the prevalence of derangement of the partial pressure of arterial carbon dioxide (PaCO2) and to determine the association between PaCO2 and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Additionally, we evaluated whether the derangement of PaCO2 was simply secondary to metabolic changes. This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 h later. The incidence rate of hypocapnia at presentation after acute CO poisoning was 67.5%, and the mean PaCO2 during the first 6 h was 33 (31–36.7) mmHg. The most common acid–base imbalance in 131 patients with hypocapnia was primary respiratory alkalosis. The incidence rate of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total range of PaCO2 variables. In multivariate regression analysis, mean PaCO2 was independently associated with ACVEs (odds ratio 0.051; 95% confidence interval 0.004–0.632). PaCO2 derangements were common after acute CO poisoning and were not explainable as a mere secondary response to metabolic changes. The mean PaCO2 during the first 6 h was associated with ACVEs. Given the high incidence of ACVEs and PaCO2 derangement and the observed association between the mean PaCO2 and ACVEs, this study suggests that (1) PaCO2 should be monitored in the acute stage to predict and/or prevent ACVEs and (2) further investigation is needed to validate this result and explore the early manipulation of PaCO2 as a treatment strategy.
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High-Sensitivity Troponin I and Creatinine Kinase-Myocardial Band in Screening for Myocardial Injury in Patients with Carbon Monoxide Poisoning. Diagnostics (Basel) 2020; 10:diagnostics10040242. [PMID: 32326299 PMCID: PMC7235999 DOI: 10.3390/diagnostics10040242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Myocardial dysfunction due to acute carbon monoxide (CO) poisoning is common and associated with poor outcomes. The role of cardiac markers, including creatine kinase-myocardial band (CK-MB), high-sensitivity troponin I (hsTnI), and brain natriuretic peptide (BNP), in identifying patients with CO-induced cardiomyopathy were evaluated. This single-center, retrospective cohort study included 905 consecutive adult patients in the CO poisoning registry from February 2009 to December 2019. Cardiomyopathy was defined as any abnormality on transthoracic echocardiography (TTE), including left ventricular systolic and diastolic dysfunction, right ventricular dysfunction, and wall motion abnormalities. The areas under receiver operating curves (AUCs) for biomarkers were compared. Of the 850 included patients, 101 (11.9%) had CO-induced cardiomyopathy. Initial and peak hsTnI and CK-MB concentrations, and initial BNP concentrations were significantly higher in patients with than without cardiomyopathy (all P-values < 0.01), but the AUCs were higher for hsTnI (0.894) and CK-MB (0.864) than for BNP (0.796). Initial TnI > 0.01 ng/mL and CK-MB > 1.5 ng/mL each had 95% sensitivity and 97% negative predictive value for CO-induced cardiomyopathy. Higher hsTnI or CK-MB levels on admission can identify patients at high-risk of CO-induced cardiomyopathy and can be a screening tool for CO poisoning.
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Doğruyol S, Akbaş I, Tekin E, Doğruyol MT. Carbon monoxide intoxication in geriatric patients: How important are lactate values at admission? Hum Exp Toxicol 2020; 39:848-854. [PMID: 32003239 DOI: 10.1177/0960327120903484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this study was to investigate the demographic and clinical characteristics and treatment modalities of elderly patients with carbon monoxide (CO) intoxication. The secondary aim was to evaluate the importance of plasma lactate values in the diagnosis of acute CO intoxication in geriatric patients. METHODS Data on geriatric patients who were admitted to the emergency department of Atatürk University Medical Faculty between January 2013 and April 2016 were analyzed retrospectively. RESULTS Of the 197 cases included in the study, 97 were in the intoxication group and 100 were in the control group; 82.5% of the intoxication cases had mild neurological symptoms and 17.5% had severe neurological symptoms. Carboxyhemoglobin levels were significantly higher in patients with severe neurological symptoms (p = 0.031). All patients with severe neurological symptoms received hyperbaric-oxygen therapy (p < 0.001). In the intoxication group, lactate levels were significantly higher than in the control group (p = 0.001). The specificity for lactate 4 mmol/L and above was found as 98.0% with a positive predictive value and negative predictive value of 84.5% and 53.3%, respectively. CONCLUSION High initial lactate levels may be a guide for cases with nonspecific symptoms in geriatric patients with suspected CO intoxication.
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Affiliation(s)
- S Doğruyol
- Department of Emergency Medicine, Alaşehir State Hospital, Manisa, Turkey
| | - I Akbaş
- Department of Emergency Medicine, Bingöl State Hospital, Bingöl, Turkey
| | - E Tekin
- Faculty of Medicine, Department of Emergency Medicine, Atatürk University, Erzurum, Turkey
| | - M T Doğruyol
- Department of Thoracic Surgery, Manisa City Hospital, Manisa, Turkey
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Zhao Y, Song YQ, Gao J, Feng SY, Li Y. Monocytes as an Early Predictor for Patients with Acute Paraquat Poisoning: A Retrospective Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6360459. [PMID: 31428640 PMCID: PMC6679898 DOI: 10.1155/2019/6360459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The predictive values of monocytes in the prognosis of patients with acute paraquat (PQ) poisoning are unclear. This retrospective study investigated the predictive values of monocytes in the prognosis of patients with acute PQ poisoning. METHODS Adult patients who suffered from acute PQ poisoning in the emergency care unit of Cangzhou Central Hospital from May 2012 to December 2018 were enrolled. The patients were divided into groups, namely, survival and nonsurvival, according to a 90-day prognosis. Moreover, correlation, logistic regression, receiver-operator characteristic (ROC), and Kaplan-Meier curve analyses were applied to evaluate the monocyte values used to predict the prognosis of patients with acute PQ poisoning. RESULT Among the 109 patients, 45 survived within 90 days after the poisoning, resulting in a 41.28% survival rate. The monocyte count of the nonsurvivors was significantly higher than that of the survivors (P< 0.001). Correlation analysis showed that monocyte count positively correlated with plasma PQ concentration (r= 0.413; P< 0.001) and negatively correlated with survival time (r= 0.512; P< 0.001) and 90-day survival (r= 0.503; P< 0.001). Logistic regression analysis showed that elevated monocytes were the independent risk factors for the 90-day survival. The area under the ROC curve of the monocyte count used to predict the 90-day survival was 0.826 (95% CI: 0.751-0.904), the optimal cut-off was 0.51×109/L, sensitivity was 73.4%, and specificity was 86.7%. CONCLUSION This study demonstrated that elevated monocyte count is a useful early predictor of 90-day survival in patients with acute PQ poisoning. However, further studies are warranted to draw firm conclusions.
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Affiliation(s)
- Yong Zhao
- Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China
| | - Ya Qi Song
- Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China
| | - Jie Gao
- Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China
| | - Shun Yi Feng
- Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China
| | - Yong Li
- Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China
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