Comparison of carbon monoxide poisonings originated from coal stove and natural gas and the evaluation of Neutrophil/Lymphocyte ratio

Year 2015, Volume: 42 Issue: 3, 299 - 304, 24.10.2015

Yahya Günaydın Kubilay Vural Mehtap Ok Yavuz Katırcı Dilber Kocaşaban Yavuz Yiğit Figen Coşkun

https://doi.org/10.5798/diclemedj.0921.2015.03.0578

Cited By: 4

Abstract

Objective: The aim of our study is to present the epidemiologic, clinical, laboratory and prognosis differences between the coal stove origin poisoning and natural gas leakages. We also aimed to investigate relationship between the severity of clinical picture, prognosis, complications develop in CO poisoning with neutrophil/lymphocyte ratio (NLR) at the initial admission.

Methods: All the acute carbon monoxide cases who applied to Ankara Training and Research Hospital Emergency Medicine Clinic between October 2009 and April 2010 were included to this prospective study. CO poisoning diagnosis was made by the history of CO poisoning with carboxyl hemoglobin (COHb) concentration is over 10%. 100 patients were included to our study.

Results: Of the patients, 55(55%) were poisoned from the coal-stove and 45(45%) from natural gas leakage. The mean COHb level of the natural gas group was significantly high (p=0.01). The mean value of GCS of the natural gas group was significantly lower (p=0.018). The number of patients with indication for HBO therapy were 17 and 6 in the natural gas group and coal-stove group, respectively, being significantly higher in the natural gas group(p=0.001). There was no statistically significant relationship between the value of NLR and values of COHb, troponin, and GCS (p=0.872, p=0.470, and p=0.896, respectively).

Conclusions: Carbon monoxide poisoning from natural gas leakage is more toxic than that from the coal-stove. There is no relationship between NLR at the time of presentation and the severity of clinical findings, prognosis and complications.

Key words: Carbon monoxide poisoning, coal-stove; natural gas, Neutrophil/lymphocyte ratio

Keywords

Carbon monoxide poisoning, coal-stove; natural gas, Neutrophil/lymphocyte ratio

Kömür sobası ve doğal gaz kaynaklı karbonmonoksit zehirlenmelerinin karşılaştırılması ve Nötrofil/Lenfosit oranının değerlendirilmesi

Abstract

Amaç: Bizim çalışmamızdaki amacımız ülkemizde karbonmonoksit (CO) zehirlenmesinin en sık nedeni olan kömür sobasından kaynaklanan zehirlenmeler ile doğal gaz kaçaklarının yol açtığı zehirlenmeler arasındaki epidemiyolojik, klinik, laboratuar ve prognoz farklılıklarını ortaya koymaktır. Ayrıca CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki nötrofil/lenfosit oranı ( NLO ) arasındaki ilişkiyi incelemeyi amaçladık.Yöntemler: Bu prospektif çalışmaya Ankara Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği’ne 2009 Ekim – 2010 Nisan tarihleri arasında başvuran akut karbonmonoksit zehirlenmesi olgularının tümü alındı. CO zehirlenmesi tanısı, anemnezinde CO zehirlenmesine neden olabilecek öykünün olması ile birlikte karboksihemoglobin (COHb) konsantrasyonunun % 10’nun üstünde olması şeklinde konuldu. Çalışmamıza toplam 100 hasta dahil edildi.Bulgular: 55 (%55) hasta kömür sobasıyla zehirlenirken, 45 (%45) hasta doğal gaz kaynaklı zehirlenmişti. Doğal gazdan zehirlenen grubun ortalama COHb düzeyi anlamlı bir şekilde daha yüksekti (p=0,01). Doğal gaz grubunun ortalama Glaskow koma skoru (GKS) değeri anlamlı bir şekilde daha düşüktü (p=0,018). Doğal gazdan zehirlenen grupta 17 hastanın HBO (hiperbarik oksijen) tedavisi ihtiyacı olurken, kömür sobasından zehirlenen grupta ise sadece 6 hastanın HBO tedavisi ihtiyacı oldu. Doğal gazdan zehirlenen grupta kömür sobasından zehirlenen gruba göre anlamlı bir şekilde HBO tedavisi ihtiyacı daha fazlaydı. (p=0,001) NLO ile COHb oranı, troponin ve GKS değerleri arasında istatistiki olarak anlamlı bir ilişki bulunmadı (Sırasıyla; p=0,872, p=0,470, p=0,896).Sonuç: Doğal gaz kaynaklı CO zehirlenmeleri kömür sobası zehirlenmelerine göre daha toksik olabilmektedir. CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki NLO arasında her hangi bir ilişki yoktur

Keywords

Karbonmonoksit zehirlenmesi, kömür sobası, doğal gaz, Nötrofil/Lenfosit oranı

References

• Raub JA, Mathiue-Nolf M, Hampson NB, et al. Carbon monoxide
• poisoning-a public health perspective. Toxicology 2000;145:1-14.
• Turan M.İ, Çayır A, Olgun H. Delayed encephalopathy after acute carbon monoxide poisoning. Dicle Med J 2014;41:217-218.
• Omaye ST. Metabolic modulation of carbon monoxide toxicity.
• Toxicology 2002;180:139-150.
• Abelsohn A, Sanborn MD, Jessiman BJ, et al. Identifying and
• managing adverse environmental health effects: 6. Carbon monoxide poisoning. CMAJ 2002;166:1685-1690.
• Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998;339:1603-1606.
• Turner M, Hamilton-Farrell MR, Clark RJ. Carbon monoxide poisoning: an update. J Accid Emerg Med 1999;16:92-96.
• Raphael JC, Elkharrat D, Jars-Guincestre MC, et al. Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication. Lancet 1989;2:414-419.
• İnal V. Carbon monoxide poisoning and treatment. Turkiye Klinikleri J Anest Reanim 2005;3:34-41.
• Choi IS. Carbon monoxide poisoning: systemic manifestations
• and complications. J Korean Med Sci 2001;16:253-261.
• Handa PK, Tai DY. Carbon monoxide poisoning: a five year review at Tan Tock Seng Hospital, Singapore. Ann Acad Med Singapore. 2005;34:611-614.
• Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-1643.
• Núñez J, Núñez E, Bodí V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101:747-752.
• Macrez R, Ali C, Toutirais O, et al. Stroke and the immune system: from pathophysiology to new therapeutic strategies. Lancet Neurol 2011;10:471-480.
• Nagai M, Terao S, Yilmaz G, et al. Roles of inflammation and the activated protein C pathway in the brain edema associated with cerebral venous sinus thrombosis. Stroke 2010;41:147-152.
• Kamisli S, Kamisli O, Gonullu S, et al. The prognostic value of increased leukocyte and neutrophil counts in the early phase of cerebral venous sinus thrombosis. Turk J Cerebrovasc Dis 2012 18:2;39-42.
• Hampson NB, Mathieu D, Piantadosi CA, et al. Carbon monoxide poisoning: interpretation of randomized clinical trials and unresolved treatment issues. Undersea Hyperb Med 2001;28:157-164.
• Brvar M, Mozina H, Osredkar J, et al. S100B protein in carbon monoxide poisoning: a pilot study. Resuscitation 2004;61:357-360.
• Kyne L, Hausdorff JM, Knight E, et al. Neutrophilia and congestive heart failure after acute myocardial infarction.Am Heart J 2000;139:94-100.
• Gazi E, Bayram B. Relationship between Neutrophil/Lymphocyte ratio and complications in patients with acute myocardial infarction. Anatol J Clin Invest 2012;6:17-20.
• Yardan T, Cevik Y, Donderici O. et al. Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning. Am J Emerg Med 2009;27:838–842.
• Ertaş G, Sönmez O, Turfan M. et al. Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation. J Neurol Sci 2013;324:49-52.