Application value of nomogram and risk factors of delayed encephalopathy after acute carbon monoxide poisoning
-
摘要: 目的:探讨中重度急性一氧化碳中毒迟发性脑病(DEACMP)的危险因素及列线图的应用价值。方法:选取2010年5月-2021年4月期间441例中重度急性一氧化碳中毒患者,根据患者2个月内是否出现DEACMP将患者分为DEACMP组(22例)及非DEACMP组(419例)。采用logistic风险回归分析筛选DEACMP的危险因素,建立预测DEACMP的列线图模型,并通过曲线下面积和校准曲线进行内部验证。结果:暴露结束后昏迷时间、脑卒中病史及肌酸激酶是DEACMP的危险因素,并以此建立列线图模型。列线图模型预测DEACMP的曲线下面积为0.964(95%CI:0.948~0.970),敏感度为94.4%,特异度为95.0%。校准曲线表明该列线图模型在预测DEACMP风险与实际DEACMP风险有较好的一致性。结论:急性一氧化碳中毒患者暴露结束后昏迷时间长、既往脑卒中病史及发病后肌酸激酶升高是DEACMP的危险因素,基于这些危险因素构建的列线图模型显示出良好的诊断性能,这有助于临床医师在临床实践中早期预测DEACMP的发生风险。Abstract: Objective:To identify the risk factors of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP) and assess the application value of nomogram for predicting DEACMP.Methods:The medical records of 441 patients admitted to Cangzhou Central Hospital between May 2010 and April 2021 due to acute carbon monoxide poisoning were retrospectively reviewed, and patients were assigned to the DEACMP group(n=22) or non-DEACMP group(n=419). Nomogram based on risk factors screened by logistic risk regression analysis was constructed, and internal validation was performed by area under the curve and calibration curve.Results:The coma duration out of exposure, history of stroke, and creatin kinase were independent risk factors for DEACMP. The area under the curve of nomogram for predicting DEACMP was 0.964(95% confidence interval:0.948-0.970), with 94.4% of sensitivity and 95.0% of specificity. The calibration curve shows that the line graph model is in good agreement with the actual DEACMP risk.Conclusion:Acute carbon monoxide poisoning patients with long coma duration out of exposure, history of stroke, and elevated creatin kinase has high risk of DEACMP. The nomogram model constructed based on these risk factors shows good diagnostic performance and contributes to predict occurrence risk of DEACMP early in clinical practice for clinicians.
-
Key words:
- carbon monoxide /
- delayed encephalopathy /
- nomogram /
- risk factors /
- prognosis
-
-
[1] 李耀宗,刘思达,胡潇,等.急性一氧化碳中毒对心脏损伤的研究进展[J].临床急诊杂志,2020,21(11):913-918.
[2] Mattiuzzi C,Lippi G.Worldwide epidemiology of carbon monoxide poisoning[J].Hum Exp Toxicol,2020,39(4):387-392.
[3] Liu Z,Meng H,Huang J,et al.Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin:a forensic retrospective study in Shanghai,China[J].Sci Rep,2021,11(1):18554.
[4] Huang YQ,Peng ZR,Huang FL,et al.Mechanism of delayed encephalopathy after acute carbon monoxide poisoning[J].Neural Regen Res,2020,15(12):2286-2295.
[5] Nah S,Choi S,Lee SU,et al.Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning:A prospective observational study[J].Medicine(Baltimore),2021,100(20):e26032.
[6] Du X,Gu H,Hao F,et al.Utility of brain CT for predicting delayed encephalopathy after acute carbon monoxide poisoning[J].Exp Ther Med,2019,17(4):2682-2688.
[7] Jiang W,Zhao Z,Wu Q,et al.Study on brain structure network of patients with delayed encephalopathy after carbon monoxide poisoning:based on diffusion tensor imaging[J].Radiol Med,2021,126(1):133-141.
[8] Wu K,Liu M,He L,et al.Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning:a resting-state fMRI study[J].Neuroradiology,2020,62(5):609-616.
[9] Di C,Zeng Y,Mao J,et al.Dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein in patients with delayed encephalopathy after acute carbon monoxide poisoning[J].Pak J Med Sci,2018,34(4):945-949.
[10] 丁晓瑜,王利,张月恒,等.醒智益脑颗粒联合高压氧治疗对一氧化碳中毒迟发性脑病患者认知和运动功能的影响[J].中国中西医结合急救杂志,2018,25(1):15-19.
[11] Zhao N,Liang P,Zhuo X,et al.After Treatment with Methylene Blue is Effective against Delayed Encephalopathy after Acute Carbon Monoxide Poisoning[J].Basic Clin Pharmacol Toxicol,2018,122(5):470-480.
[12] Ran T,Nurmagambetov T,Sircar K.Economic implications of unintentional carbon monoxide poisoning in the United States and the cost and benefit of CO detectors[J].Am J Emerg Med,2018,36(3):414-419.
[13] Liao SC,Shao SC,Yang KJ,et al.Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning[J].Sci Rep,2021,11(1):19212.
[14] 王思琪,赵年.1H-MRS对一氧化碳中毒迟发性脑病的预测[J].中国中西医结合影像学杂志,2021,19(4):330-334.
[15] Xu SY,Li CX,Li LY,et al.Wallerian degeneration of bilateral cerebral peduncles after acute carbon monoxide poisoning[J].BMC Neurol,2020,20(1):96.
[16] 杨俊礼,韩永燕,李伟,等.乌司他丁用于早期需呼吸支持的急性重度一氧化碳中毒合并心肌损伤的疗效观察[J].临床急诊杂志,2021,22(1):1-5.
[17] Gao Y,Gu H,Yang J,et al.Prognosis of patients in prolonged coma after severe carbon monoxide poisoning[J].Hum Exp Toxicol,2021,40(8):1355-1361.
[18] 方秋实,陈志军.昏迷时间与一氧化碳中毒发生迟发性脑病的关系[J].中国急救复苏与灾害医学杂志,2020,15(z1):61-62.
[19] 王运锋,陈风兰,郑惠之,等.急性一氧化碳中毒迟发性脑病的临床特征及危险因素[J].西部医学,2020,32(10):1496-1499.
[20] 张振贵,俞作发,李剑峰,等.肌酸激酶与一氧化碳中毒严重程度的关系及预测价值[J].新疆医学,2019,49(12):1229-1231.
[21] Park JH,Heo R,Kang H,et al.Diagnostic performance and optimal cut-off values of cardiac biomarkers for predicting cardiac injury in carbon monoxide poisoning[J].Clin Exp Emerg Med,2020,7(3):183-189.
[22] 曹双清,高珣,刘倩,等.急性一氧化碳中毒性心脏病预后影响因素分析[J].中华急诊医学杂志,2021,29(8):1093-1098.
[23] 徐志森.中-重度急性一氧化碳中毒患者急诊的预后影响因素[J].中外医学研究,2017,15(30):38-39.
[24] 陶金胜,孙瑞文.原有脑血管病的一氧化碳中毒病例分析[J].实用医技杂志,1995,2(5):349-350.
[25] 李晟,陈潜妙,池学锋,等.急性一氧化碳中毒后迟发性脑病预测因子的研究[J].浙江医学,2019,41(11):1150-1153.
[26] Kim YS,Cha YS,Kim MS,et al.The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning[J].Hum Exp Toxicol,2018,37(6):587-595.
[27] 刘永建,刘桓,王双豹,等.早期脑电双频指数监测联合乳酸清除率与急性重度一氧化碳中毒迟发性脑病的相关性研究[J].中华劳动卫生职业病杂志,2021,39(4):258-261.
[28] 曹文元,刘庆新.血清cTnI、Lac、CK-MB、LDH、CRP及NSE与一氧化碳中毒迟发性脑病的关系[J].蚌埠医学院学报,2017,42(11):1479-1482.
[29] Suzuki Y.Risk factors for delayed encephalopathy following carbon monoxide poisoning:Importance of the period of inability to walk in the acute stage[J].PLoS One,2021,16(3):e0249395.
-
计量
- 文章访问数: 198
- PDF下载数: 125
- 施引文献: 0
下载: