title: Serum bilirubin value predicts hospital admission in carbon monoxide-poisoned patients. Active player or simple bystander?
abstract: OBJECTIVE
  Although carbon monoxide poisoning is a major medical emergency, the armamentarium of recognized prognostic biomarkers displays unsatisfactory diagnostic performance for predicting cumulative endpoints.
  
  
  METHODS
  We performed a retrospective and observational study to identify all patients admitted for carbon monoxide poisoning during a 2-year period. Complete demographical and clinical information, along with the laboratory data regarding arterial carboxyhemoglobin, hemoglobin, blood lactate and total serum bilirubin, was retrieved.
  
  
  RESULTS
  The study population consisted of 38 poisoned patients (23 females and 15 males; mean age 39 ± 21 years). Compared with discharged subjects, hospitalized patients displayed significantly higher values for blood lactate and total serum bilirubin, whereas arterial carboxyhemoglobin and hemoglobin did not differ. In a univariate analysis, hospitalization was significantly associated with blood lactate and total serum bilirubin, but not with age, sex, hemoglobin or carboxyhemoglobin. The diagnostic performance obtained after combining the blood lactate and total serum bilirubin results (area under the curve, 0.90; 95% CI, 0.81-0.99; p<0.001) was better than that obtained for either parameter alone.
  
  
  CONCLUSIONS
  Although it remains unclear whether total serum bilirubin acts as an active player or a bystander, we conclude that the systematic assessment of bilirubin may, alongside lactate levels, provide useful information for clinical decision making regarding carbon monoxide poisoning.
authors.affiliation: Emergency Department, Academic Hospital of Parma, IT.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
authors.affiliation: Emergency Department, Academic Hospital of Parma, IT.
authors.forename: Ivan
authors.initials: I
authors.lastname: Comelli
authors.affiliation: Laboratory of Clinical Chemistry and Haematology, Academic Hospital of Parma, IT.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Buonocore
authors.affiliation: Laboratory of Clinical Chemistry and Haematology, Academic Hospital of Parma, IT.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Picanza
authors.affiliation: Emergency Department, Hospital of Vaio, Fidenza, IT.
authors.forename: Gianni
authors.initials: G
authors.lastname: Rastelli
authors.affiliation: Laboratory of Clinical Chemistry and Haematology, Academic Hospital of Parma, IT.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002249:Carbon Monoxide Poisoning / Q000097:blood*; D002263:Carboxyhemoglobin / Q000032:analysis; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D023381:Endpoint Determination / Q000592:standards*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D019344:Lactic Acid; D002263:Carboxyhemoglobin; D001663:Bilirubin