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Huang CC, Chen TH, Ho CH, Chen YC, Chang WT, Hsu CC, Lin HJ, Chang CP, Guo HR. Hypothyroidism following carbon monoxide poisoning: An epidemiological study supported by animal experiments. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 283:116772. [PMID: 39053183 DOI: 10.1016/j.ecoenv.2024.116772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Previous studies have suggested a possible association between carbon monoxide poisoning (COP) and hypothyroidism, but the evidence is limited. Therefore, the aim of this study was to further investigate this relationship. Using data from the Taiwan National Health Research Database, we identified 32,162 COP patients and matched with 96,486 non-COP patients by age and index date for an epidemiological study. The risk of hypothyroidism was compared between the two cohorts until 2018. Independent predictors of hypothyroidism were analyzed using competing risk analysis. An animal study was also conducted to support the findings. COP patients had an increased risk of hypothyroidism compared to non-COP patients in the overall analysis (adjusted hazard ratio [AHR]= 3.88; 95 % confidence interval [CI]: 3.27-4.60) and in stratified analyses by age, sex, and comorbidities. The increase in the overall risk persisted even after more than six years of follow-up (AHR= 4.19; 95 % CI: 3.18-5.53). Independent predictors of hypothyroidism, in addition to COP, included age ≥65 years, female sex, hyperlipidemia, and mental disorder. The animal study showed damages in the hypothalamus, pituitary gland, and thyroid, as well as altered hormone levels 28 days after COP exposure. The epidemiological results showed an increased risk of hypothyroidism in COP patients, which was further supported by the animal study. These findings suggest the need for close monitoring of thyroid function in COP patients, especially in those who are age ≥65 years, female, and have hyperlipidemia or mental disorder.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tzu-Hao Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Ting Chang
- School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan.
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Alharthy N, Alanazi A, Almoqaytib A, Alharbi B, Alshaibani R, Albuniyan J, Alshibani A. Demographics and clinical characteristics of carbon monoxide poisoning for patients attending in the emergency department at a tertiary hospital in Riyadh, Saudi Arabia. Int J Emerg Med 2024; 17:25. [PMID: 38408885 PMCID: PMC10895805 DOI: 10.1186/s12245-024-00600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Carbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It can lead to the development of Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to describe the demographics and characteristics of CO poisoning patients attending at the Emergency Department (ED) and assess the association between CO intoxication and the development of DNS in a tertiary hospital, Riyadh, Saudi Arabia. METHODS A retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning and attended to the ED at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMRC). RESULTS A total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of those, 76% were adults with an average age of 32.36 (SD ± 15.20) and 51% were male adults. Five (6%) of the 85 patients developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at 2 to 10 days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, Gender was significantly associated with the development of DNS (20% male vs. 80% female, p = 0.050). CONCLUSIONS The findings of this study are consistent with previous published studies showing low proportions of patients who were exposed to CO poisoning at risk of developing DNS. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning.
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Affiliation(s)
- Nesrin Alharthy
- Pediatrics Emergency Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Aljohara Alanazi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alreem Almoqaytib
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bedour Alharbi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rakad Alshaibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jawaher Albuniyan
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Huang CC, Chen TH, Ho CH, Chen YC, Chen RJ, Wang YJ, Hsu CC, Lin HJ, Wang JJ, Chang CP, Guo HR. Risks of Developing Diabetes and Hyperglycemic Crisis Following Carbon Monoxide Poisoning: A Study Incorporating Epidemiologic Analysis and Animal Experiment. Clin Epidemiol 2022; 14:1265-1279. [PMID: 36345392 PMCID: PMC9636896 DOI: 10.2147/clep.s380990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues. Methods Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning. Results Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18–1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52–2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus. Conclusion Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan,Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Correspondence: Chien-Cheng Huang, Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan, Tel +886-6-281-2811, Fax +886-6-281-6161, Email
| | - Tzu-Hao Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Rong-Jane Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Jan Wang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan,Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan,How-Ran Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, Tainan, 701, Taiwan, Tel +886-6-235-3535, Fax +886-6-275-2484, Email
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Huang CC, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Su SB, Guo HR. Association between carbon monoxide poisoning and adrenal insufficiency: a nationwide cohort study. Sci Rep 2022; 12:16219. [PMID: 36171402 PMCID: PMC9519538 DOI: 10.1038/s41598-022-20584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 09/15/2022] [Indexed: 12/02/2022] Open
Abstract
Carbon monoxide poisoning may damage the brain and adrenal glands, but it is unclear whether it is associated with adrenal insufficiency. We identified all COP patients diagnosed between 1999 and 2012 in Taiwan using the Nationwide Poisoning Database and selected a reference cohort (participants without COP) from the same database by exact matching of age and index date at a 1:2 ratio. Participants with a history of adrenal insufficiency or steroid use of more than 14 days were excluded. We followed up participants until 2013 and compared the risk of developing adrenal insufficiency between the two cohorts. The 21,842 COP patients had a higher risk for adrenal insufficiency than the 43,684 reference participants (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI]: 1.8–3.5) after adjustment for sex and underlying comorbidities (liver disease, thyroid disease, mental disorder). The risk continued to elevate even after 1 year (AHR = 2.1; 95% CI: 1.4–3.4). The COP patients who had acute respiratory failure had an even higher risk for adrenal insufficiency than those without acute respiratory failure, which may indicate a dose–response relationship. Stratified analyses showed that female patients had an elevated risk (AHR = 3.5; 95% CI: 2.1–6.0), but not male patients. Younger patients (< 50 years) had higher risks, and the AHR reached statistical significance in the age groups 20–34 (AHR = 5.5; 95% CI: 1.5–20.6) and 35–49 (AHR = 4.9; 95% CI: 2.3–10.6) years old. The risk for developing adrenal insufficiency elevated after COP, especially in female and younger patients. Carbon monoxide is the most common gaseous agent causing acute intoxication worldwide. Results of the current study call for monitoring adrenal function of patients with COP.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Bin Su
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan.,Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. .,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan. .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
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Chiang MY, Shao SC, Liao SC. Validation of Diagnostic Codes to Identify Carbon Monoxide Poisoning in Taiwan’s Claims Data. Front Pharmacol 2022; 13:882632. [PMID: 35784736 PMCID: PMC9240270 DOI: 10.3389/fphar.2022.882632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: Previous studies identified the study cohort or outcome of carbon monoxide poisoning (COP) by using the relevant disease diagnosis codes in secondary databases, but the validity of diagnosis codes of COP is unclear in such secondary databases. This study aimed to evaluate the accuracy of case definitions for COP using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes in Taiwan’s health insurance claims data. Methods: We selected a 10% simple random sample from an original cohort of patients newly undergoing carboxyhemoglobin (COHb) testing under any clinical diagnosis at four Chang Gung Memorial Hospitals in Taiwan during 2011–2020. Two clinical doctors independently ascertained the COP diagnosis by reviewing the medical records as the reference standard. We estimated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various case definitions (e.g., ICD-9-CM code, ICD-10-CM code and the uses of hyperbaric oxygen therapy) in the claims data. Results: We randomly selected 557 cases from the original cohort of 5,571 cases newly receiving COHb test in the study hospitals. We found 90, 35, and 9 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 278 cases with an ICD-9-CM code of 986. A further 111, 34, and 6 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 279 cases with an ICD-10-CM code of T58. Using ICD-9-CM codes, the sensitivity, specificity, PPV and NPV for COP were 90.9, 80.4, 72, and 94.1%, respectively. Using ICD-10-CM codes they were 94.9, 79, 76.6, and 95.5%, respectively. PPV typically increased when COP was the primary diagnosis and could reach 100% if patients with ICD-CM code 986 or T58 also received hyperbaric oxygen therapy during hospitalization. Conclusion: The COP-related ICD-CM codes alone did not accurately identify COP patients, but accuracy improved after including oxygen therapy data with the ICD-CM codes in Taiwan’s claims data.
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Affiliation(s)
- Min-Ying Chiang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Shu-Chen Liao,
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Wang CH, Shao SC, Chang KC, Hung MJ, Yang CC, Liao SC. Quantifying the Effects of Climate Factors on Carbon Monoxide Poisoning: A Retrospective Study in Taiwan. Front Public Health 2021; 9:718846. [PMID: 34722435 PMCID: PMC8553011 DOI: 10.3389/fpubh.2021.718846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Carbon monoxide (CO) poisoning is the leading cause of poisoning death worldwide, but associations between CO poisoning and weather remain unclear. Objective: To quantify the influence of climate parameters (e.g., temperature, relative humidity, and wind speed) on the incidence risk of acute CO poisoning in Taiwan. Methods: We used negative binomial mixed models (NBMMs) to evaluate the influence of weather parameters on the incidence risk of acute CO poisoning. Subgroup analyses were conducted, based on the seasonality and the intentionality of acute CO poisoning cases. Results: We identified a total of 622 patients (mean age: 32.9 years old; female: 51%) with acute CO poisoning in the study hospital. Carbon monoxide poisoning was associated with temperature (beta: -0.0973, rate ratio (RR): 0.9073, p < 0.0001) but not with relative humidity (beta: 0.1290, RR: 1.1377, p = 0.0513) or wind speed (beta: -0.4195, RR: 0.6574, p = 0.0806). In the subgroup analyses, temperature was associated with the incidence of intentional CO poisoning (beta: 0.1076, RR: 1.1136, p = 0.0333) in spring and unintentional CO poisoning (beta: -0.1865, RR: 0.8299, p = 0.0184) in winter. Conclusion: Changes in temperature affect the incidence risk for acute CO poisoning, but the impact varies with different seasons and intentionality in Taiwan. Our findings quantify the effects of climate factors and provide fundamental evidence for healthcare providers to develop preventative strategies to reduce acute CO poisoning events.
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Affiliation(s)
- Chien-Ho Wang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kai-Cheng Chang
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Jui Hung
- Section of Cardiology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ning K, Zhou YY, Zhang N, Sun XJ, Liu WW, Han CH. Neurocognitive sequelae after carbon monoxide poisoning and hyperbaric oxygen therapy. Med Gas Res 2021; 10:30-36. [PMID: 32189667 PMCID: PMC7871936 DOI: 10.4103/2045-9912.279981] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Carbon monoxide (CO) has been the leading cause of poisoning mortality in many countries and hyperbaric oxygen (HBO) is a widely accepted treatment for CO poisoning. However, some patients with CO poisoning will still develop neurocognitive sequelae regardless of HBO therapy, which can persist since CO poisoning or be present days to weeks after a recovery from CO poisoning. HBO has been used in the prevention and treatment of neurocognitive sequelae after CO poisoning, and some mechanisms are also proposed for the potential neuroprotective effects of HBO on the neurocognitive impairment after CO poisoning, but there is still controversy on the effectiveness of HBO on neurocognitive sequelae after CO poisoning. In this paper, we briefly introduce the neurocognitive sequelae after CO poisoning, summarize the potential predictive factors of neurocognitive sequelae, and discuss the use of HBO in the treatment and prevention of neurocognitive sequelae after CO poisoning.
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Affiliation(s)
- Ke Ning
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Yan-Yan Zhou
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ning Zhang
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Xue-Jun Sun
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Wen-Wu Liu
- Department of Diving and Hyperbaric Medicine, Naval Medical University, Shanghai, China
| | - Cui-Hong Han
- Department of Pathology, the Affiliated No 1 People's Hospital of Jining City, Jining Medical University, Jining, Shandong Province, China
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Wei KY, Liao CY, Chung CH, Lin FH, Tsao CH, Sun CA, Lu KC, Chien WC, Wu CC. Carbon Monoxide Poisoning and Chronic Kidney Disease Risk: A Nationwide, Population-Based Study. Am J Nephrol 2021; 52:292-303. [PMID: 33887746 DOI: 10.1159/000515383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/20/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patients with carbon monoxide poisoning (COP) commonly have long-term morbidities. However, it is not known whether patients with COP exhibit an increased risk of developing chronic kidney disease (CKD) and whether hyperbaric oxygen therapy (HBOT) alters this risk. METHODS This study identified 8,618 patients who survived COP and 34,464 propensity score-matched non-COP patients from 2000 to 2013 in a nationwide administrative registry. The primary outcome was the development of CKD. The association between COP and the risk of developing CKD was estimated using a Cox proportional hazards regression model; the cumulated incidence of CKD among patients stratified by HBOT was evaluated using a Kaplan-Meier analysis. RESULTS After adjusting for covariates, the risk of CKD was 6.15-fold higher in COP patients than in non-COP controls. Based on the subgroup analyses, regardless of demographic characteristics, environmental factors, and comorbidities, the COP cohort exhibited an increased risk of developing CKD compared with the controls. The cumulative incidence of CKD in COP patients did not differ between the HBOT and non-HBOT groups (p = 0.188). CONCLUSIONS COP might be an independent risk factor for developing CKD. Thus, clinicians should enhance the postdischarge follow-up of kidney function among COP patients.
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Affiliation(s)
- Kuang-Yu Wei
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Chen-Yi Liao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Kuo-Cheng Lu
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Wu-Chien Chien
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
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Huang CC, Chen TH, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Chang CP, Guo HR. Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning. Circ Heart Fail 2021; 14:e007267. [PMID: 33866825 DOI: 10.1161/circheartfailure.120.007267] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carbon monoxide poisoning (COP) is an important public health issue around the world. It may increase the risk of myocardial injury, but the association between COP and congestive heart failure (CHF) remains unclear. We conducted a study incorporating data from epidemiological and animal studies to clarify this issue. METHODS Using the National Health Insurance Database of Taiwan, we identified patients with COP diagnosed between 1999 and 2012 and compared them with patients without COP (non-COP cohort) matched by age and the index date at a 1:3 ratio. The comparison for the risk of CHF between the COP and non-COP cohorts was made using Cox proportional hazards regression. We also established a rat model to evaluate cardiac function using echocardiography and studied the pathological changes following COP. RESULTS The 20 942 patients in the COP cohort had a higher risk for CHF than the 62 826 members in the non-COP cohort after adjusting for sex and underlying comorbidities (adjusted hazard ratio, 2.01 [95% CI, 1.74-2.32]). The increased risk of CHF persisted even after 2 years of follow-up (adjusted hazard ratio, 1.85 [95% CI, 1.55-2.21]). In the animal model, COP led to a decreased left ventricular ejection fraction on echocardiography and damage to cardiac cells with remarkable fibrotic changes. CONCLUSIONS Our epidemiological data showed an increased risk of CHF was associated with COP, which was supported by the animal study. We suggest close follow-up of cardiac function for patients with COP to facilitate early intervention and further studies to identify other long-term effects that have not been reported in the literature.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.).,Department of Senior Services (C.-C. Huang), Southern Taiwan University of Science and Technology, Tainan
| | - Tzu-Hao Chen
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.)
| | - Chung-Han Ho
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (C.-H.H.)
| | - Yi-Chen Chen
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology (C.-C. Hsu), Southern Taiwan University of Science and Technology, Tainan
| | - Hung-Jung Lin
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H.-J.L.)
| | - Jhi-Joung Wang
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center (J.-J.W.), Southern Taiwan University of Science and Technology, Tainan
| | - Ching-Ping Chang
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.).,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H.-R.G.).,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University, Tainan Taiwan (H.-R.G.)
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10
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Yang CC, Chuang YF, Chen PE, Tao P, Tung TH, Chien CW. The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy. Medicine (Baltimore) 2021; 100:e24183. [PMID: 33466193 PMCID: PMC7808522 DOI: 10.1097/md.0000000000024183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.
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Affiliation(s)
- Chih-Chieh Yang
- Department of Business Administration, Ming Chuan University, Taipei
- Department of Critical Care Medicine, Lotung Poh-Ai Hospital, Yilan
| | - Yi-Fei Chuang
- Department of Business Administration, Ming Chuan University, Taipei
| | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University
- Taiwan Association of Health Industry Management and Development, Taipei
| | - Ping Tao
- Division of Medical fees, Department of Medical Affair Administration, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Tao-Hsin Tung
- Enze Medical Research Center, Affiliated Taizhou Hospital of Wenzhou Medical College, Taizhou, Zhejiang,
- Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
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11
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Chen CK, Chan YL, Su TH. Incidence of intoxication events and patient outcomes in Taiwan: A nationwide population-based observational study. PLoS One 2020; 15:e0244438. [PMID: 33362242 PMCID: PMC7757892 DOI: 10.1371/journal.pone.0244438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intoxicated patients were frequently managed in the emergency departments (ED) with few studies at national level. The study aimed to reveal the incidence, outcomes of intoxications and trend in Taiwan. METHODS Adults admitted to an ED due to an intoxication event between 2006 and 2013 were identified using the Taiwan National Health Insurance Research Database. The rate of intoxication and severe intoxication events, mortality rate, hospital length of stay (LOS), and daily medical costs of these patients were analyzed. Changes over time were analyzed using Joinpoint models. Multivariable generalized regressions with GEE were used to assess the effect of sex, age, and presence of prior psychiatric illness. RESULTS A total of 20,371 ED admissions due to intoxication events were identified during the study period, and the incidence decreased with annual percentage change of 4.7% from 2006 to 2013. The mortality rate, hospital LOS, and daily medical costs were not decreased over time. Males and geriatric patients had more severe intoxication events, greater mortality rates, and greater daily medical costs. Patients with psychiatric illnesses had higher mortality rates and a longer hospital LOS, but lower daily medical expenses. CONCLUSION From 2006 to 2013, there was a decline in the incidence of ED admission for intoxication events in Taiwan. Males, geriatric patients, and those with psychiatric illnesses had greater risks for severe intoxication and mortality.
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Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail:
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12
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Huang CC, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Guo HR. Autoimmune Connective Tissue Disease Following Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Clin Epidemiol 2020; 12:1287-1298. [PMID: 33262659 PMCID: PMC7686473 DOI: 10.2147/clep.s266396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background In addition to hypoxia, oxidative stress and inflammation due to carbon monoxide (CO) poisoning cause adverse health effects. These mechanisms are related to the occurrence of autoimmune connective tissue disease, but studies on the association between CO poisoning and autoimmune connective tissue disease are limited. We conducted a study to evaluate the occurrence of autoimmune connective tissue disease following CO poisoning. Methods We identified participants with CO poisoning diagnosed between 1999 and 2012 from the Nationwide Poisoning Database and selected participants without CO poisoning from the Taiwan National Health Insurance Research Database with matching age and index dates at a 1:3 ratio. Sex, underlying comorbidities, and monthly income were also included in the analyses. We followed up the participants until 2013 and made comparison of the risk of autoimmune connective tissue disease between participants with and without CO poisoning. Results The 23,877 participants with CO poisoning had a higher risk for autoimmune connective tissue disease than the 71,631 participants without CO poisoning (adjusted hazard ratio [AHR], 3.5; 95% confidence interval [CI], 3.1–3.9) after adjustment for sex, diabetes, Lyme disease, herpes zoster, infectious mononucleosis, hepatitis, HIV infection, liver disease, renal disease, non-CO poisoning or drug abuse, malignancy, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and monthly income. An increased risk was observed even after 4 years of follow-up (AHR, 3.6; 95% CI, 3.0–4.4). Conclusion The risk of autoimmune connective tissue disease increased following CO poisoning. Close follow-up of the patients with CO poisoning for the development of connective tissue disease is recommended, and further investigation of the detailed mechanisms is warranted.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
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13
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Impact of carbon monoxide poisoning on the risk of breast cancer. Sci Rep 2020; 10:20450. [PMID: 33235264 PMCID: PMC7687884 DOI: 10.1038/s41598-020-77371-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
Carbon monoxide (CO) is a toxic gas and an endogenous signaling molecule. Some studies involving cell lines have revealed the potential antibreast cancer effects of CO. Data on such effects in humans, however, are limited. Thus, we conducted a study on patients with CO poisoning (COP) to evaluate the effects of CO on the risk of breast cancer. We identified female patients who were diagnosed with COP over the period of 2002 and 2009 from the Nationwide Poisoning Database of Taiwan. For comparison, we selected females without COP from the National Health Insurance Research Database. Participants in the COP and comparison cohorts were matched on the index year, age, monthly income, and geographic region of residence at a 1:6 ratio. We followed up the two cohorts until the end of 2014 and compared their risks of developing breast cancer. We included 7053 participants with COP and 42,318 participants without COP. Participants with COP were at a lower risk of developing breast cancer than those without COP (0.7% vs. 1.0%, p < 0.001). Cox proportional hazard regression analyses revealed that COP was associated with a hazard ratio of 0.67 (95% confidence interval [95% CI] 0.50–0.90) for breast cancer after we adjusted for age, monthly income, geographic region, and comorbidities of hypertension, diabetes, and hyperlipidemia. Our result provides evidence for the potential protective effects of CO against breast cancer in humans. Further studies that directly evaluate the potential effects are warranted.
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14
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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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15
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Effects of Hyperbaric Oxygen Therapy on Acute Myocardial Infarction Following Carbon Monoxide Poisoning. Cardiovasc Toxicol 2019; 20:291-300. [DOI: 10.1007/s12012-019-09552-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Huang CC, Ho CH, Chen YC, Hsu CC, Lin HJ, Su SB, Wang JJ, Guo HR. Increased risk for hypothyroidism associated with carbon monoxide poisoning: a nationwide population-based cohort study. Sci Rep 2019; 9:16512. [PMID: 31712674 PMCID: PMC6848088 DOI: 10.1038/s41598-019-52844-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/14/2019] [Indexed: 11/09/2022] Open
Abstract
Carbon monoxide poisoning (COP) may cause injuries to the central nervous and endocrine systems, which might increase the risk of developing hypothyroidism. We wanted to evaluate the association between COP and the risk of developing hypothyroidism because epidemiological data on this potential association are limited. We conducted a nationwide population-based cohort study using the Nationwide Poisoning Database and identified 24,328 COP subjects diagnosed between 1999 and 2012. By matching the index date and age, we selected 72,984 non-COP subjects for comparison. Subjects with thyroid diseases and malignancy before 1999 were excluded. We followed up the two groups of subjects until 2013 and compared the risk of developing hypothyroidism. COP subjects had a significantly higher risk for hypothyroidism than non-COP subjects (adjusted hazard ratio [AHR]: 3.8; 95% confidence interval [CI]: 3.2-4.7) after adjusting for age, sex, underlying comorbidities, and monthly income, and the AHR was particular higher in subjects with diabetes mellitus, hyperlipidemia, and mental disorder. The increased risk was highest in the first month after COP (AHR: 41.0; 95% CI: 5.4-310.6), and the impact remained significant even after 4 years. In conclusion, COP was associated with an increased risk for hypothyroidism. Further studies regarding the underlying mechanisms are warranted.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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17
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Wang W, Cheng J, Zhang J, Wang K. Effect of Hyperbaric Oxygen on Neurologic Sequelae and All-Cause Mortality in Patients with Carbon Monoxide Poisoning: A Meta-Analysis of Randomized Controlled Trials. Med Sci Monit 2019; 25:7684-7693. [PMID: 31606731 PMCID: PMC6807531 DOI: 10.12659/msm.917065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hyperbaric oxygen (HBO) is used in patients with carbon monoxide (CO) poisoning to prevent the occurrence of delayed neurological sequelae. However, inconsistent results were obtained regarding the treatment effects of HBO. Therefore, the current meta-analysis was conducted based on published randomized controlled trials (RCTs) to determine the effect of HBO on neurologic sequelae and all-cause mortality in patients with CO poisoning. MATERIAL AND METHODS Electronic databases MedLine, EmBase, and the Cochrane Library were searched for relevant RCTs from inception to March 1, 2019. The pooled relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the outcomes by using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also conducted. RESULTS Seven RCTs, including 9 cohorts and a total of 2023 patients with CO poisoning, were enrolled in this study. The summary results revealed that HBO showed an association with lower risk of memory impairment compared to patients receiving normobaric oxygen (NBO), whereas 2 sessions of HBO showed an association with higher risk of memory impairment compared to those who received 1 session of HBO. Moreover, HBO was associated with increased neuropsychologic scores of block design and trail making when compared with NBO. No other significant differences regarding the treatment effects of HBO were observed. CONCLUSIONS These results indicate that HBO therapy significantly reduces the risk of memory impairment compared to NBO, but 2 sessions of HBO might not be better for memory impairment than 1 session of HBO.
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Affiliation(s)
- Weiqiang Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Department of General Practice, Suzhou Hospital of Anhui Medical University/Suzhou Municipal Hospital, Suzhou, Anhui, P.R. China
| | - Jincheng Cheng
- Department of Neurology, No. 123 Hospital of Nanjing Military Command, Chinese People’s Liberation Army (CPLA), Bengbu, Anhui, P.R. China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, P.R. China
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18
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Ke YT, Feng IJ, Hsu CC, Wang JJ, Su SB, Huang CC, Lin HJ. Nurses have a four-fold risk for overdose of sedatives, hypnotics, and antipsychotics than other healthcare providers in Taiwan. PLoS One 2018; 13:e0202004. [PMID: 30089164 PMCID: PMC6082541 DOI: 10.1371/journal.pone.0202004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
Nurses have high work stress that may contribute to an increased overdose for sedatives, hypnotics, and antipsychotics (OSHA). We conducted this nationwide population-based cross-sectional study to clarify this still unclear issue. We used a nationwide database to identify 110,379 nurses, 22,032 other healthcare providers (HCPs), and an identical number of individuals from the general population matched by age and sex. We compared the period prevalence of OSHA between nurses and the general population, other HCPs and the general population, and nurses and other HCPs, among nurse subgroups from 2006 to 2012. The risk for OSHA in nurses and in the general population was not significantly different after adjusting for anxiety, insomnia, depression, schizophrenia, and affective disorders (adjusted odds ratio [AOR]: 1.145; 95% confidence interval [CI]: 0.974-1.346). However, in the age subgroups < 35 years, nurses had higher risk than the general population of having OSHA (AOR: 1.333; 95% CI: 1.109-1.601). Other HCPs had a significantly lower risk for OSHA than the general population (AOR: 0.237; 95% CI: 0.122-0.460). Nurses had a significantly higher risk for OSHA than other HCPs (AOR: 3.902; 95% CI: 2.159-7.048). Comparison among nurses showed that younger nurses (< 35 years) had a significantly higher risk for OSHA than the older nurses (≥ 50 years) (AOR: 3.569; 95% CI: 1.252-10.330). Registered nurses had significantly higher risk for OSHA than registered professional nurses (AOR: 1.810; 95% CI: 1.405-2.332); and nurses from clinics, local hospitals, and regional hospitals had significantly higher risk than nurses from medical centers. This study delineated that nurses had a nearly four-fold risk for OSHA when compared to other HCPs. Younger nurses, registered nurses, and nurses from clinics, local hospitals, and regional hospitals had higher risks for OSHA than their respective nurse controls; it suggests that more attention should be given to the occupational health of these populations.
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Affiliation(s)
- Ya-Ting Ke
- Nursing Department, Chi-Mei Medical Center, Tainan, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- * E-mail: (CCH); (HJL)
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail: (CCH); (HJL)
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