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


CONCLUSIONS
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.
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Chung-Hsuan
CH
Ku
Department of Pediatrics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Huei-Min
HM
Hung
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Wa Cheong
WC
Leong
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Hsiao-Hui
HH
Chen
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Ja-Liang
JL
Lin
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Wen-Hung
WH
Huang
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Huang-Yu
HY
Yang
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Cheng-Hao
CH
Weng
Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Che-Min
CM
Lin
Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Shwu-Hua
SH
Lee
Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
I-Kuan
IK
Wang
Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
Chih-Chia
CC
Liang
Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
Chiz-Tzung
CT
Chang
Department of Gastroenterology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Wey-Ran
WR
Lin
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan; Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
Tzung-Hai
TH
Yen
D000293:Adolescent; D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult