Risk factors and outcome analysis of delayed neurological sequelae in elderly patients with carbon monoxide poisoning
Yuehong Ma1,2, Wenying Lv3, Huijun Hu2, Shuyi Pan2, Dazhi Guo2
1 Department of Hyperbaric Oxygen, School of Medicine, South China University of Technology, Guangzhou, 510006, China
2 Department of Hyperbaric Oxygen, 6th Medical Center of PLA General Hospital, Beijing, 100048, China
3 Department of Hyperbaric Oxygen, Southern Medical University, Guangzhou, 510145, China
ABSTRACT
Carbon monoxide (CO) poisoning is one of the common causes of poisoning and can result in significant neurological sequelae. However, few studies have focused on the elderly patient population. We retrospectively reviewed elderly (age≥65 years) with CO poisoning from non-fire accidents and non-suicide at the 6th Medical Center PLA General Hospital in China from 2013 to 2023. A total of 167 patients were enrolled. The annual case number decreased from 2013 to 2023, particularly during the cold months (November to February). The most common source of exposure was coal heating (90%). The most common presenting symptoms were consciousness changes (90%). Eighty-eight patients (52%) developed delayed neurological sequelae (DNS), of which sixty-nine (78%) converted to long-term neurological sequelae (LNS). The most common imaging manifestations were hypoxic-ischemic damage in the basal ganglia (54%) and demyelination in white matter (46%). After multivariate analysis, initial GCS score and coma time (GCS scores＜8) were the independent risk factors for patients with DNS (p＜0.001). Interestingly, myocardial injury was more common in non-DNS elderly patients than in DNS patients (p＜0.001); only coma time was an independent risk factor for patients with LNS (p＜0.001). There was no significant difference between HBO2 (p=0.196) and NBO (p=0.379) in the occurrence of DNS and LNS in elderly patients with CO poisoning. Therefore, initial GCS score and coma time (GCS scores＜8) may be the risk factors of DNS, and coma time may be a high-risk factor for poor prognosis in elderly patients with CO poisoning. Moreover, HBO2 treatment did not show benefit or harm to those patients. Special attention should be given, and follow-up should be performed on elderly patients, particularly those who have longer coma time and CO exposure time and lower initial GCS scores in acute CO poisoning.
Keywords: carbon monoxide poisoning; delayed neurological sequelae; elderly risk factors; outcome
Key points:
1. We retrospectively reviewed elderly (age≥65 years) with CO poisoning from non-fire accidents and non-suicide at the 6th Medical Center PLA General Hospital in China from 2013 to 2023.
2. Special attention should be given, and follow-up should be performed on elderly patients, particularly those who have longer coma time and CO exposure time and lower initial GCS scores in acute CO poisoning.