Outcome of patients with carbon monoxide poisoning at a far-east poison center.

Abstract

INTRODUCTION:

Many cases of carbon monoxide poisoning in Taiwan are due to burning charcoal. Nevertheless, few reports have analyzed the mortality rate of these patients who survive to reach a hospital and die despite intensive treatment. Therefore, this study examined the clinical features, physiological markers, and outcomes after carbon monoxide poisoning and the associations between these findings.

METHODS:

We analyzed the records of 261 patients who were referred for management of carbon monoxide intoxication between 2000 and 2010. Patients were grouped according to status at discharge as alive (survivor, n = 242) or dead (non-survivor, n = 19). Demographic, clinical, laboratory, and mortality data were obtained for analysis.

RESULTS:

Approximately half of the cases (49.4%) attempted suicide by burning charcoal. Most of the patients were middle-aged adults (33±19 years), and were referred to our hospital in a relatively short period of time (6±10 hours). Carbon monoxide produced many serious complications after exposure: fever (26.1%), hypothermia (9.6%), respiratory failure (34.1%), shock (8.4%), myocardial infarction (8.0%), gastrointestinal upset (34.9%), hepatitis (18.4%), renal failure (25.3%), coma (18.0%) and rhabdomyolysis (21.8%). Furthermore, the non-survivors suffered greater incidences of hypothermia (P<0.001), respiratory failure (P<0.001), shock (P<0.001), hepatitis ((P=0.016), renal failure (P=0.003), coma (P<0.001) than survivors. All patients were treated with high concentration of oxygen therapy using non-rebreather mask. However, hyperbaric oxygen therapy was only used in 18.8% of the patients. In a multivariate-Cox-regression model, it was revealed that shock status was a significant predictor for mortality after carbon monoxide poisoning (OR 8.696, 95% CI 2.053-37.370, P=0.003). Finally, Kaplan-Meier analysis confirmed that patients with shock suffered greater cumulative mortality than without shock (Log-rank test, Chi-square 147.404, P<0.001).

CONCLUSION:

The mortality rate for medically treated carbon monoxide-poisoned patients at our center was 7.3%. Furthermore, the analysis indicates that shock was most strongly associated with higher risk of mortality.

• Authors: Chung-Hsuan Ku, Huei-Min Hung, Wa Cheong Leong, Hsiao-Hui Chen, Ja-Liang Lin, Wen-Hung Huang, Huang-Yu Yang, Cheng-Hao Weng, Che-Min Lin, Shwu-Hua Lee, I-Kuan Wang, Chih-Chia Liang, Chiz-Tzung Chang, Wey-Ran Lin, Tzung-Hai Yen
• Journal: PloS one (PLoS One) Vol. 10 Issue 3 Pg. e0118995 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 25745854 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Carbon Monoxide Poisoning (therapy)
• Female
• Humans
• Male
• Middle Aged
• Poison Control Centers
• Retrospective Studies
• Taiwan
• Treatment Outcome
• Young Adult