Elevated S100B level in cerebrospinal fluid could predict poor outcome of carbon monoxide poisoning

Dexamethasone therapy prevents delayed neuropsychiatric sequelae after carbon monoxide poisoning: a prospective registry-based study

BACKGROUND

Delayed neuropsychiatric sequelae are major complications of carbon monoxide poisoning; carbon monoxide triggers brain oxidation and inflammation. Corticosteroids such as dexamethasone modulate neurological damage after carbon monoxide poisoning through anti-inflammatory actions and immune response inhibition. However, it is not known whether corticosteroids prevent delayed neuropsychiatric sequelae. We thus studied whether dexamethasone reduced the incidence of delayed neuropsychiatric sequelae.

METHODS

This registry-based study enrolled patients with carbon monoxide poisoning treated in a Korean tertiary care hospital from March 1^st, 2020 to November 30^th, 2021. Data of patients were prospectively collected during the study period, and retrospectively analyzed. One group received intravenous dexamethasone. We performed multivariable logistic regression analysis to identify factors associated with delayed neuropsychiatric sequelae.

RESULTS

A total of 128 patients were enrolled, of which 99 patients received dexamethasone therapy and 29 patients did not. The incidences of delayed neuropsychiatric sequelae in the dexamethasone and non-dexamethasone groups were 16.2% and 37.9%, respectively. Multivariable logistic regression analysis revealed that dexamethasone use (odds ratio = 0.122, 95% confidence interval 0.031-0.489) and a higher Glasgow Coma Scale (odds ratio = 0.818, 95% confidence interval 0.682-0.981) was associated with a lower incidence of delayed neuropsychiatric sequelae.

CONCLUSION

Early dexamethasone treatment was significantly associated with a decreased incidence of delayed neuropsychiatric sequelae. A higher Glasgow Coma Scale at presentation also was associated with a lower incidence of delayed neuropsychiatric sequelae.

A pilot study of neuroprotective effect of granulocyte colony-stimulating factor (G-CSF) in patients with carbon monoxide poisoning: a double-blind, randomized, placebo-controlled trial

Although neuroprotective effects of granulocyte colony-stimulating factor (G-CSF) have been shown in rats exposed to carbon monoxide (CO), this pilot clinical trial was performed to assess the feasibility of treatment with G-CSF in patients with acute CO poisoning. A double-blind, randomized, placebo-controlled pilot clinical trial was conducted on twenty-six patients with acute CO poisoning. G-CSF (90 μg/kg) was administered intravenously for 72 h. Demographic data, routine laboratory tests, differential blood counts, venous blood gas, and adverse reactions were recorded. The primary endpoint was brain ischemia improvement based on CT findings and the secondary endpoints examined improvements in the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index as well as S-100β concentrations. Fourteen patients received G-CSF, and 12 received a placebo. Twenty-six were followed for 30 days and no one in both groups died during follow-up. Neurological complications, brain ischemic changes, Barthel, and mRS were compared between the two groups on determined days after the onset of therapeutic intervention, and no significant differences were observed between the two groups. Favorable results were achieved for treated patients by different measures; NIHSS was decreased 72 h after treatment (p = 0.046), and S-100β levels were significantly higher in the G-CSF group than in the control group, 12 h and 72 h after the treatment. G-CSF appears to have potential effects on several clinical parameters in patients with acute CO poisoning. The trial was registered at the Iranian Registry of Clinical Trials with the ID: (IRCT201607232083N7).

Prediction of delayed neuropsychiatric sequelae after carbon monoxide poisoning via serial determination of serum neuron-specific enolase levels

BACKGROUND

Neuron-specific enolase (NSE) is released into serum when nerve cells are damaged, and the levels thereof are used to determine neurological prognosis in patients who have suffered cardiac arrest or stroke. Delayed neuropsychiatric sequelae (DNS), a major complication of carbon monoxide poisoning (COP), can be caused by inflammatory response which is a mechanism of neuronal injury in cardiac arrest and stroke. NSE is known as a predictor of neurological prognosis in ischemic brain injury after cardiac arrest, and it is also reported as a predictor of DNS in acute COP. When serum NSE is measured serially in cardiac arrest patients, the best time to predict neurological prognosis is known at 48-72 h, but there are no studies analyzing serial serum NSE in acute COP. Thus, we explored whether serum NSE levels measured three times at 24 h intervals after COP predicted the development of DNS.

METHODS

This prospective observational study was conducted on patients treated for COP from May 2018 to April 2020 in a tertiary care hospital in Korea. Neuron-specific enolase levels were assessed 24, 48, and 72 h after presentation at hospital. We used logistic regression to explore the association between NSE levels and DNS development.

RESULTS

The NSE level was highest at 48 h, and the difference between the DNS group and the non-DNS group was greatest on the same time point. On multivariable logistic regression analysis, the NSE level at 48 h of >20.98 ng/mL (odds ratio [OR], 3.570; 95% confidence interval [CI], 1.412-9.026; P = .007) and the initial Glasgow Coma Scale (GCS) score of <9 (OR, 4.559; 95% CI, 1.658-0.12.540; P = .003) was statistically significant for DNS development.

CONCLUSION

Early identification of those who will experience DNS in acute COP patients is clinically important for deciding treatment. In this study, we revealed that NSE level of >20.98 ng/mL at 48 h time point can be used as an independent predictor of DNS (OR, 3.570; 95% CI, 1.412-9.026; P = .007; AUC, 0.648).

Serum NSE and S100B protein levels for evaluating the impaired consciousness in patients with acute carbon monoxide poisoning

The aim of this study was to investigate the associations between the levels of neuron-specific enolase (NSE) and S100B protein and coma duration, and evaluate the optimal cut-off values for prediction coma duration ≥ 72 hours in patients with acute carbon monoxide poisoning (ACOP).A total of 60 patients with ACOP were divided into 3 following groups according to their status of consciousness and coma duration at admission: Awake group [Glasgow Coma Scale score (GCS score) ≥ 13 points], Coma < 72 hours group (GCS score < 13 points and coma duration < 72 h), and Coma ≥ 72 hours group (GCS score < 13 points and coma duration ≥ 72 h). The levels of serum NSE and S100B protein were measured after admission.There were significant differences in GCS score, carbon monoxide (CO) exposure time, NSE, and S100B levels between the Coma ≥ 72 h group and the Awake group, and between the Coma < 72 h group and the Awake group. Significant differences in GCS score, NSE, and S100B levels were also found between Coma ≥ 72 h group and Coma < 72 h group. Correlation analysis showed that NSE and S100B were positively correlated (rs = 0.590, P < .01); NSE and S100B were negatively correlated with GCS score (rs = -0.583, rs = -0.590, respectively, both P < .01). The areas under the curve (AUCs) of NSE, S100B, and GCS score to predict the coma duration ≥ 72 hours were 0.754, 0.791, and 0.785, respectively. Pairwise comparisons did not show differences among the 3 groups (all P > .05). The sensitivity and specificity of NSE prediction with a cut-off value of 13 μg/L were 80% and 64%, respectively, and those of S100B prediction with a cut-off value of 0.43 μg/L were 70% and 88%, respectively.The NSE and S100B protein levels were significantly correlated with the degree of impaired consciousness and had the same clinical value in predicting coma duration of ≥ 72 hours in patients with ACOP.

Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: A prospective observational study

Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.

Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study

Introduction: Carbon monoxide (CO) poisoning can result in delayed neurological sequelae (DNS). Factors predicting DNS are still controversial. This study aims to determine whether acute brain lesions observed using diffusion-weighted magnetic resonance imaging (MRI) following acute CO poisoning are related to the subsequent development of DNS. Methods: This prospective study was conducted on patients with CO poisoning treated at a university hospital in Bucheon, Korea. From August 2016 to July 2019, a total of 283 patients visited the hospital because of CO poisoning. Exclusion criteria included age under 18 years, refusing hyperbaric oxygen therapy, refusing MRI, being discharged against medical advice, being lost to follow-up, having persistent neurological symptoms at discharge, and being transferred from another hospital 24 h after exposure. Results: Of the 154 patients included in the final study, acute brain lesions on MRI (ABLM) were observed in 49 patients (31.8%) and DNS occurred in 30 patients (19.5%). In a logistic regression analysis, lower Glasgow coma scale score and higher exposure time were associated with DNS, and the presence of ABLM in white matter was significantly associated with DNS (OR 6.741; 95% CI, 1.843–24.660; p = 0.004). Conclusion: The presence of ABLM in white matter was significantly related to the occurrence of DNS. Early prediction of the risk of developing DNS through MRI may be helpful in treating patients with CO poisoning.

S-100β in predicting the need of hyperbaric oxygen in CO-induced delayed neurological sequels

BACKGROUND

Delayed neurological sequels (DNS) have been described after carbon monoxide (CO) poisoning. There is a need to find a new prognostic marker to guide the use of hyperbaric oxygen (HBO) therapy.

AIM

To evaluate serum S-100β level in patients presenting with acute CO poisoning as an indicator of poisoning severity and predictor of DNS occurrence and HBO need in those patients.

METHODS

This prospective cohort study included patients with acute CO poisoning. On admission, carboxyhemoglobin (COHb) and S-100β levels were measured. Patients were followed up for 6 months for signs of DNS.

RESULTS

Out of 50 patients, 6 only developed DNS. The mean of S-100β levels was significantly higher in patients with severe poisoning and those with DNS. Receiver operating characteristic curve analysis revealed that S-100β had an area under the curve 0. 871; at a cutoff value ≥ 0.67 µg/L, its sensitivity and specificity were 100% and 77.3%, respectively. The sensitivity of S-100β was significantly higher than that of COHb, while its specificity and overall accuracy were significantly higher than those of HBO criteria.

CONCLUSION

Serum S-100β level on admission could be a marker of poisoning severity and a predictor of CO-induced DNS development that guides the use of HBO therapy.

Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6

Objective

Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning.

Methods

Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning.

Results

Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×10⁵; 95% CI, 4.56×10² to 9.00×10¹⁰] in model 1, [AOR, 3.69×10⁵; 95% CI, 2.49×10² to 2.71×10¹¹] in model 2) were independently associated with DNS development.

Conclusion

Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.

Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning

BACKGROUND

This study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning.

METHODS

A total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6 months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome).

RESULTS

A total of 432 patients (median age: 55 years, range: 17-91 years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894, respectively.

CONCLUSION

Initial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients.

Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning

OBJECTIVE

This study aimed to investigate whether clinical parameters and serum neuron-specific enolase (NSE) levels measured at emergency department (ED) presentation help stratify the risk of acute or delayed persistent severe neurological sequelae after acute carbon monoxide (CO) poisoning induced by charcoal burning.

METHODS

This retrospective study included 236 patients who suffered from CO poisoning. Demographic information, serum NSE levels measured in the ED, treatment, clinical course, and long-term neurological outcomes were recorded.

RESULTS

The median serum NSE level at presentation was 15.5 (10.9-22.7) ng/mL. No differences were observed in the duration of CO exposure; the initial Glasgow Coma Scale (GCS) score; the levels of arterial HCO₃^-, white blood cells (WBCs), C-reactive protein (CRP) or troponin I; or the frequency of abnormal diffusion-weighted imaging finding at presentation among the groups with different serum NSE levels at presentation. The incidences of acute and delayed persistent neurologic sequelae assessed at 22.3 months after acute charcoal CO poisoning were 5.1% and 8.5%, respectively. No difference in the NSE level was observed between patients stratified according to long-term neurological status. According to the multinomial logistic regression analysis, age, serum CRP levels and the initial GCS score were risk factors for the two types of persistent severe neurological sequelae, whereas troponin I levels were associated only with the acute persistent severe neurological sequelae. However, the adjusted NSE level was not a risk factor for any persistent neurological sequelae.

CONCLUSIONS

Serum NSE levels at presentation were not correlated with the risk of acute or delayed persistent neurological sequelae. Further studies with blood sampling at optimal time points and serial measurements should be conducted. Age, initial GCS score, and CRP levels may be risk factors for persistent severe neurological sequelae.

Risk factors for the delayed onset of neuropsychologic sequelae following carbon monoxide poisoning

Aim

Carbon monoxide (CO) poisoning often manifests delayed neuropsychological sequelae. The risks and preventive factors for the development of delayed neuropsychological sequelae are controversial at present. The purpose of this retrospective study was to assess the risk factors for this condition.

Method

We studied 81 patients with CO poisoning admitted to the Critical Care and Emergency Medicine Center at the Kansai Medical University from 2006 to 2012. All patients (64 males and 17 females; average age, 45.9 years) were divided into non‐ delayed neuropsychological sequelae and delayed neuropsychological sequelae groups and retrospectively studied. Patient data were analyzed by univariate and multivariate analyses.

Results

The results of our study indicated that prolonged CO exposure, elevated serum creatinine phosphokinase levels, head image abnormality in the basal ganglion or white matter region, low Glasgow Coma Scale score, bedsore occurrence, and CO poisoning attributable to burning charcoal were each predictive risk factors for the development of delayed neuropsychological sequelae. Bedsore occurrence and serum creatinine phosphokinase elevation were significant risk factors by multivariate analysis, whereas no significant differences were found for age, gender, mean blood pressure, heart rate, arterial carboxyhemoglobin and lactate concentrations, or base excess.

Conclusion

We identified several predictive risk factors of delayed neuropsychological sequelae. We believe that these factors will contribute to identifying optimum therapeutic methods and follow‐up terms for patients with acute CO poisoning at risk of developing delayed neuropsychological sequelae.

Serum S100B Protein as an Outcome Prediction Tool in Emergency Department Patients with Traumatic Brain Injury

OBJECTIVES

Traumatic brain injury is a common cause of death and disability worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement.

METHODS

In this prospective study, the clinical conditions of patients with mild to moderate traumatic brain injury (TBI) were assessed, and patient serum S100B levels were measured. Patients were followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student's t-test and the chi-square test were used for data analysis, which was performed using SPSS software.

RESULTS

The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (23.1±14.2 ng/dl and 134.0±245.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (632.18±516.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 24.97±22.9 ng/dl in patients with normal CT results; 41.56±25.7 ng/dl in patients with skull bone fracture; 57.38 ±28.9 ng/dl in patients with intracranial hemorrhage; and 76.23±38.3 ng/dl in patients with fracture plus intracranial hemorrhage).

CONCLUSIONS

Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance.

Serum S100B level may be correlated with carbon monoxide poisoning

OBJECTIVE

To investigate the correlation between serum S100B level and carbon monoxide (CO) poisoning by meta-analysis.

METHODS

By searching both English and Chinese language-based electronic databases (PubMed, EBSCO, Ovid, Springerlink, Wiley, Web of Science, Wanfang databases, China national knowledge infrastructure (CNKI), VIP database, etc.) thoroughly, we tabulated and analyzed the collected data with the use of Comprehensive Meta-analysis 2.0 (CMA 2.0).

RESULTS

Totally 108 studies have been searched initially (92 studies in Chinese, 16 studies in English). Nine case-control studies (4 studies in English, 5 in Chinese) were chosen for an updated meta-analysis including 542 patients with CO poising and 236 healthy controls. Results identified that the serum S100B level were obviously higher than that in healthy controls (SMD=1.600, 95% CI=1.055-2.145, P<0.001). A subgroup based on the ethnicities revealed that the serum S100B level in Caucasian and Asian subgroups was clearly higher than serum S100B level in healthy controls (Asians: SMD=2.0624, 95% CI=1.736-3.511, P<0.001; Caucasians: SMD=0.447, 95% CI=0.197-0.697, P<0.001).

CONCLUSION

Serum S100B level may be correlated with the CO poisoning and could be effective biomarker for early diagnosis and treatment monitoring in CO poisoning.

Carbon monoxide intoxication

Carbon monoxide (CO) is a colorless, odorless, nonirritant gas that accounts for numerous cases of CO poisoning every year from a variety of sources of incomplete combustion of hydrocarbons. These include poorly functioning heating systems, indoor propane-powered forklifts, indoor burning of charcoal burning briquettes, riding in the back of pick-up trucks, ice skating rinks using propane-powered resurfacing machines, and gasoline-powered generators that are not in correct locations. Once CO is inhaled it binds with hemoglobin to form carboxyhemoglobin (COHb) with an affinity 200 times greater than oxygen that leads to decreased oxygen-carrying capacity and decreased release of oxygen to tissues leading to tissue hypoxia. Ischemia occurs with CO poisoning when there is loss of consciousness that is accompanied by hypotension and ischemia in the arterial border zones of the brain. Besides binding to many heme-containing proteins, CO disrupts oxidative metabolism leading to the formation of free radicals. Once hypotension and unconsciousness occur with CO poisoning, lipid peroxidation and apoptosis follow. Because COHb has a short half-life, examination of other biomarkers of CO neurotoxicity that reflect inflammation or neuronal damage has not demonstrated consistent results. The initial symptoms with CO exposure when COHb is 15-30% are nonspecific, namely, headache, dizziness, nausea, fatigue, and impaired manual dexterity. However individuals with ischemic heart disease may experience chest pain and decreased exercise duration at COHb levels between 1% and 9%. COHb levels between 30% and 70% lead to loss of consciousness and eventually death. Following resolution of acute symptoms there may be a lucid interval of 2-40 days before the development of delayed neurologic sequelae (DNS), with diffuse demyelination in the brain accompanied by lethargy, behavior changes, forgetfulness, memory loss, and parkinsonian features. Seventy-five percent of patients with DNS recover within 1 year. Neuropsychologic abnormalities with chronic CO exposure are found even when magnetic resonance imaging (MRI) and magnetic resonance spectroscopy are normal. White-matter damage in the centrum semiovale and periventricular area and abnormalities in the globus pallidus are most commonly seen on MRI following CO exposure. Though not as common, toxic or ischemic peripheral neuropathies are associated with CO exposure in humans and animals. The cornerstone for treatment for CO poisoning is 100% oxygen using a tight-fitting mask for greater than 6 hours. The indications for treatment with hyperbaric oxygen to decrease the half-life of COHb remain controversial.

The role of S100B protein, neuron-specific enolase, and glial fibrillary acidic protein in the evaluation of hypoxic brain injury in acute carbon monoxide poisoning

The main purpose of this study was to assess the role of S100B protein, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP) in the evaluation of hypoxic brain injury in acute carbon monoxide (CO)-poisoned patients. This cross-sectional study was conducted among the patients with acute CO poisoning who referred to the emergency department in a 1-year period. Serum levels of S100B protein, NSE, and GFAP were determined on admission. A total of 55 CO-poisoned patients (mean age ± standard deviation, 45 ± 20.3 years; 60% women) were included in the study. The control group consisted of 25 healthy adults. The patients were divided into two groups according to whether they were conscious or unconscious. The serum levels of S100B, NSE, and GFAP were higher in patients than that in the control group. There was no significant difference between unconscious and conscious patients with respect to these markers. There was a statistically significant difference between the conscious and unconscious patients and the control group in terms of S100B and NSE levels. There was also a statistically significant difference between the unconscious patients and the control group in terms of GFAP levels. Increased serum S100B, NSE, and GFAP levels are associated with acute CO poisoning. These biomarkers can be useful in assessing the clinical status of patients with CO poisoning.

S100b protein levels in subretinal fluid in rhegmatogenous retinal detachment

PURPOSE

To investigate the relevance of the concentration of S100B in subretinal fluid (SRF) with the postoperative anatomical and functional success and proliferative vitreoretinopathy (PVR) formation parameters in rhegmatogenous retinal detachment (RRD).

METHODS

Fifty-three patients (34 male, 19 female) were included in this prospective study. Study group consisted of 46 patients who had scleral buckling (SB) surgery with the diagnosis of RRD. Control group consisted of six patients who had pars plana vitrectomy (PPV) for either full-thickness macular hole or subluxated intraocular lens. SRFs were obtained during SB surgery. Study cases were divided into three groups, corresponding to the duration of retinal detachment (DRD). Clinical characteristics including best-corrected visual acuity (BCVA), anatomical status at 6 months, the presence of postoperative PVR that resulted in recurrent detachment and any possible re-operations were recorded. The concentration of S100B was quantified by using an enzyme immunoassay test kit.

RESULTS

The concentration of S100B in SRF increased significantly after RRD. And, S100B levels were evidently elevated in concordance with DRD. There was no correlation between the concentration of SRF - S100B with preoperative or postoperative BCVA. Again, S100B levels were not related to the extent of RRD or postoperative PVR formation.

CONCLUSION

Concentration of S100B in SRF is good marker of retinal stress and increases in concordance with DRD. However it would not help to predict the possible anatomical and functional success or postoperative PVR formation.

The usefulness of the serum s100b protein for predicting delayed neurological sequelae in acute carbon monoxide poisoning

CONTEXT

Some patients with acute carbon monoxide poisoning will experience delayed neurological sequelae. Several factors associated with delayed neurological sequelae have been reported, but these factors are unsatisfactory for the assessment of unconscious patients.

OBJECTIVE

The aim of this study was to assess the usefulness of the serum S100B protein as a biochemical marker for predicting delayed neurological sequelae.

MATERIALS AND METHODS

In this retrospective study, we evaluated the data for patients who visited an emergency medical center once during a period of 7 months. The enrollment criteria were the diagnosis of acute carbon monoxide poisoning and the measurement of the serum S100B level. A standardized extraction using medical records was performed.

RESULT

A total of 71 patients were enrolled, and 10 patients (14.1%) presented delayed neurological sequelae. The delayed neurological sequelae group had a longer duration of carbon monoxide exposure, a longer duration of loss of consciousness, and a worse mental status (p-value < 0.001). In addition, the S100B protein levels were higher in the delayed neurological sequelae group (0.891 vs. 0.063, p-value < 0.001). Multiple logistic regression analysis showed that only the serum S100B protein level was independently associated with the development of delayed neurological sequelae (OR, 120.594; 95% CI, 4.194-3467.220), and a serum S100B protein level of more than 0.165 μg/L predicted the development of delayed neurological sequelae (sensitivity 90%, specificity 87%).

DISCUSSION AND CONCLUSION

In the present study, the level of serum S100B protein was found to be useful for evaluating acute CO poisoning patients and was found to be an independent predictor of the development of DNS after acute CO poisoning.