title: Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning.
abstract: Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Cha
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.affiliation: 2 Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: H H
authors.initials: HH
authors.lastname: Do
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: H I
authors.initials: HI
authors.lastname: Kim
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: O H
authors.initials: OH
authors.lastname: Kim
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: K-C
authors.initials: KC
authors.lastname: Cha
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: K H
authors.initials: KH
authors.lastname: Lee
authors.affiliation: 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: S O
authors.initials: SO
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002249:Carbon Monoxide Poisoning / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology / Q000523:psychology; D042241:Early Diagnosis; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology / Q000523:psychology; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010751:Phosphopyruvate Hydratase
keywords: Carbon monoxide; complications; neurotoxicity; poisoning