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Diagnostic performance and optimal cut-off values of cardiac biomarkers for predicting cardiac injury in carbon monoxide poisoning

Clinical and Experimental Emergency Medicine 2020년 7권 3호 p.183 ~ 189
진영호, Heo Ran, 강형구, 오재훈, 임태호, 고벽성,
소속 상세정보
진영호 ( Jin Young-Ho ) - Hanyang University College of Medicine Department of Emergency Medicine
 ( Heo Ran ) - Hanyang University Medical Center Department of Internal Medicine
강형구 ( Kang Hyung-Goo ) - Hanyang University College of Medicine Department of Emergency Medicine
오재훈 ( Oh Jae-Hoon ) - Hanyang University College of Medicine Department of Emergency Medicine
임태호 ( Lim Tae-Ho ) - Hanyang University College of Medicine Department of Emergency Medicine
고벽성 ( Ko Byuk-Sung ) - Hanyang University College of Medicine Department of Emergency Medicine

Abstract


Objective: This study aimed to compare the diagnostic performance of cardiac biomarkers and to evaluate the optimal cut-off values for echocardiographic cardiac injury prediction in patients with carbon monoxide (CO) poisoning.

Methods: This retrospective observational cohort study included adult patients with acute CO poisoning. Patients who did not undergo transthoracic echocardiography, which was used to define patients with cardiac injury (ejection fraction <55%), were excluded. The area under the curve was used to evaluate diagnostic performance for cardiac injury prediction. Mann-Whitney U, chi-square, and Fisher exact tests were used to analyze data.

Results: After excluding the 27 patients who did not undergo echocardiography, 114 patients were included in the study. Fifteen (13.2%) patients had cardiac injury. The area under the curve values for the B-type natriuretic peptide, creatine kinase-myocardial band, and troponin I were 0.711 (95% confidence interval [CI], 0.527?0.895; P=0.011), 0.766 (95% CI, 0.607?0.926; P=0.001), and 0.801 (95% CI, 0.647?0.955; P<0.001), respectively, with optimal cut-off values of 330 pg/mL, 10.1 ng/mL, and 0.455 ng/mL, respectively. The sensitivity, specificity, and positive and negative predictive values of troponin I were 67%, 91%, 53%, and 95%, respectively.

Conclusion: Troponin I showed the best diagnostic performance for predicting cardiac injury in patients with CO poisoning. A cut-off value of 0.455 ng/mL appeared optimal for cardiac injury prediction. However, further studies on cardiac biomarkers and other diagnostic tools in CO poisoning are needed given the low sensitivity of troponin I.

키워드

Carbon monoxide; Poisoning; Echocardiography

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