Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Association between Smoking and Delayed Neuropsychological Sequelae in Acute Carbon Monoxide Poisoning

급성 일산화탄소 중독 환자들에서 흡연과 지연성 신경정신과학적 후유증 발생의 상관관계

  • Kim, Hak Myeon (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Choi, Sung Woo (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Nah, Sang Un (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Choi, Hyo Jeong (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Lim, Hoon (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Gi Woon (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Han, Sang Soo (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Lee, Young Hwan (Department of Emergency Medicine, College of Medicine, Soonchunhyang University)
  • 김학면 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 최성우 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 나상운 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 최효정 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 임훈 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 김기운 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 한상수 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 이영환 (순천향대학교 의과대학 부천병원 응급의학과)
  • Received : 2018.09.27
  • Accepted : 2018.11.22
  • Published : 2018.12.31
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Abstract

Purpose: This study examined the association between smoking and delayed neuropsychological sequelae (DNS) in acute carbon monoxide (CO) poisoning. Methods: Patients admitted to the medical center emergency department from March 2016 to March 2017 because of CO poisoning were examined retrospectively. The patients were divided into two groups: DNS and Non-DNS group. Multiple factors were analyzed to explain DNS, which was assessed by motor disturbances, cognitive impairment, dysphagia, Parkinson-like syndromes, epilepsy, and emotional lability in CO poisoning. Results: A total of 120 patients were included. The factors related to DNS were smoking (pack-years) (p=0.002) and initial carbon monoxide-hemoglobin level (p=0.015). On the other hand, after multivariate logistic regression analysis, smoking (Odds ratio 1.07; 95% CI, 1.02-1.13; p=0.004) was the only factor associated with DNS. Conclusion: Smoking is a very reliable factor for predicting the occurrence of DNS. A history of smoking in patients who suffer from CO intoxication is important. If a patient smokes, treatment should be started actively and as soon as possible.

Keywords

References

  1. Choi BH, Jeon J, Ryoo SM, Seo DW, Kim WY, Oh BJ, et al. Recent Epidemiologic Features of Carbon Monoxide Poisoning in Korea: A Single Center Retrospective Cohort Study. J Korean Soc Clin Toxicol 2012;10:80-4.
  2. Oh S, Choi SC. Acute carbon monoxide poisoning and delayed neurological sequelae: a potential neuroprotection bundle therapy. Neural Regen Res 2015;10:36-8. https://doi.org/10.4103/1673-5374.150644
  3. Piantadosi CA. Diagnosis and treatment of carbon monoxide poisoning. Respir Care Clin N Am 1999;5:183-202.
  4. Angela LC, Nicholas AB. Carbon monoxide poisoning in the 21st century. Crit Care 2014;18:221. https://doi.org/10.1186/cc13846
  5. Choi SA, Choi IS. Clinical manifestations and complications in carbon monoxide intoxication. J Korean Neurol Assoc 1998 Aug;16:500-5.
  6. Lindell KW, Ramona OH, Karen JC, Susan C, Gregory E, Terry PC, James FO, et. al. Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning. N Engl J Med 2002;347:1057-67. https://doi.org/10.1056/NEJMoa013121
  7. Giuseppe P, Matteo C, Peiman N, Simone V, Massimo DP, Francesco G, Primo B, et. al. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study. Scand J Trauma Resusc Emerg Med 2011;19:16. https://doi.org/10.1186/1757-7241-19-16
  8. Park EJ, Ahn JH, Min YG, Jung YS, Kim KS, Lee JS, Choi SC. The usefulness of the serum s100b protein for predicting delayed neurological sequelae in acute carbon monoxide poisoning. Clin Toxicol 2012;50:183-8. https://doi.org/10.3109/15563650.2012.658918
  9. Moon JM, Shin MH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol 2011;30:836-43. https://doi.org/10.1177/0960327110384527
  10. Cha YS, Kim H, Do HH, Kim HI, Kim OH, Cha KC, et al. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol 2018;37:240-6. https://doi.org/10.1177/0960327117698544
  11. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. J Am Coll Cardiol 2004 May 19;43:1731-7.
  12. Bolinder G, Alfredsson L, Engulund A, de Faire U. Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Am J Public Health 1994;84:399-404. https://doi.org/10.2105/AJPH.84.3.399
  13. Connelly KA, Roifman I. STEMI, the Smoker's Paradox, and Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging. 2018 Jul 13. pii: S1936-878X(18)30510-2. doi: 10.1016/j.jcmg.2018.04.029.
  14. Ali SF, Smith EE, Bhatt DL, Fonarow GC, Schwamm LH. Paradoxical association of smoking with in-hospital mortality among patients admitted with acute ischemic stroke. J Am Heart Assoc 2013 Jun 21;2(3):e000171. doi: 10.1161/JAHA.113.000131
  15. Hormuzdiyar HD, Robert FR, Pui MRL, Timothy RS, Kai UF, William BG, et. al. Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis. J Neurosurg 2018;129:446-57.
  16. Alexandra R. The 'smoker's paradox' after in-hospital cardiac arrest. Nat Rev Cardiol 2014;11:374.
  17. Barbash GI, White HD, Modan M, Diaz R, Hampton JR, Heikkila J, et al. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993;87:53-8. https://doi.org/10.1161/01.CIR.87.1.53
  18. Moon JM, Chun BJ, Lee SD, Jung EJ. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol 2018;56:751-8. https://doi.org/10.1080/15563650.2017.1415347
  19. Rasmussen LS, Poulsen MG, Christiansen M, Jansen EC. Biochemical markers for brain damage after carbon monoxide poisoning. Acta Anaesthesiol Scand 2004;48:469-73. https://doi.org/10.1111/j.1399-6576.2004.00362.x
  20. Philip AW, Ralph BD, William BK, Ruth B, Albert JB. Cigarette Smoking as a Risk Factor for Stroke The Framingham Study. JAMA 1988;259:1025-9. https://doi.org/10.1001/jama.1988.03720070025028
  21. P. Appelros, I. Nydevik, M. Viitanen. Poor outcome after firstever stroke: predictors for death, dependency, and recurrent stroke within the first year. Stroke 2003;34:122-6. https://doi.org/10.1161/01.STR.0000047852.05842.3C
  22. Elneihoum AM, Goransson M, Falke P, Janzon L. Threeyear survival and recurrence after stroke in Malmo, Sweden: an analysis of stroke registry data. Stroke 1998;29:2114-7. https://doi.org/10.1161/01.STR.29.10.2114
  23. Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology 1998;50:208-16. https://doi.org/10.1212/WNL.50.1.208
  24. Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994;44:626-34. https://doi.org/10.1212/WNL.44.4.626
  25. Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, et. al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000;31:2080-6. https://doi.org/10.1161/01.STR.31.9.2080
  26. Kimura K, Minematsu K, Kazui S, Yamaguchi T. Mortality and cause of death after hospital discharge in 10,981 patients with ischemic stroke and transient ischemic attack. Cerebrovasc Dis 2005;19:171-8. https://doi.org/10.1159/000083252
  27. Albertsen IE, Overvad TF, Lip GY, Larsen TB. Smoking, atrial fibrillation, and ischemic stroke: a confluence of epidemics. Curr Opin Cardiol 2015;30:512-7. https://doi.org/10.1097/HCO.0000000000000205