Karbon monoksit zehirlenmesinde troponin yükselmesini öngörmede sistemik immün-inflamasyon indeksi ve eritrosit dağılım genişliği-lenfosit oranının tanısal değeri

Amaç: Çalışmamızın amacı, karbon monoksit zehirlenmesi (KMZ) olan hastalarda sistemik inflamatuar indeks (SII) ve eritrosit dağılım genişliği/lenfosit oranının (RLR) troponin yükselmesini öngörmedeki tanısal değerini değerlendirmekti. Gereç ve Yöntem: Retrospektif kesitsel bir çalışma tasarımına dayanan bu çalışma, hastanenin acil servisine KMZ ile başvuran 18 yaş ve üstü hastalar arasında yapıldı. Seri troponin ölçümleri sonucunda hastalar troponin pozitif ve negatif gruplara ayrıldı. Troponin pozitifliğini tahmin etmek için nötrofil/lenfosit oranı (NLR), monosit-lenfosit oranı (MLR), RLR ve SII'nin eşik değerini belirlemek için alıcı işlem karakteristiği (ROC) analizi kullanıldı.. Bulgular: Bu çalışmaya 50'sinde pozitif troponin testi bulunan CO maruziyeti olan 195 hasta dahil edildi. NLR, RLR, MLR ve SII'nin troponin pozitifliğini belirlemek için tanısal gücünün kabul edilebilir olduğu keşfedildi (AUC: 0.71-0.77). ROC eğrisi karşılaştırmalarına göre, bu inflamatuar biyobelirteçler arasında tanısal bir fark yoktu. Artan NLR, RLR, MLR ve SII'nin CO maruziyetinden sonra troponin pozitifliğinin bağımsız öngörücüleri olduğu bulundu (Odds oranı sırasıyla: 8.65, 4.31, 7.24, 6.31). Sonuç: Basit, ucuz ve kolay erişilebilir parametreler olan SII ve RLR, COP olgularında troponin pozitifliğini öngörmede değerlidir.

Anahtar Kelimeler:

Karbon monoksit zehirlenmesi, kardiyak hasar, sistemik immün-inflamasyon indeks, monosit-lenfosit oranı, RDW-lenfosit oranı, nötrofil-lenfosit oranı, troponin.

Diagnostic value of systemic immune-inflammation index and red cell distribution width-lymphocyte ratio in predicting troponin elevation in carbon monoxide poisoning

Purpose: The aim of our study was to assess the significant value of the systemic inflammatory index (SII) and red cell distribution width/lymphocyte ratio (RLR) in patients with carbon monoxide poisoning (COP). Materials and Methods: Based on a retrospective cross-sectional study design, this study was conducted among patients 18 years and older who presented to the hospital's emergency department with COP. The patients were separated into troponin positive and negative groups as an outcome of serial troponin measurements. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value of neutrophil/lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), RLR, and SII to predict troponin positivity. Results: This study included 195 patients with CO exposure, 50 of whom had positive troponin tests. It was discovered that the diagnostic power of NLR, RLR, MLR, and SII was acceptable for identifying troponin positivity (AUC: 0.71-0.77). According to ROC curve comparisons, there was no diagnostic difference between these inflammatory biomarkers. Increased NLR, RLR, MLR, and SII were found to be independent predictors of troponin positivity after CO exposure (Odds ratio respectively: 8.65, 4.31, 7.24, 6.31). Conclusion: SII and RLR, which are simple, inexpensive, and easily accessible parameters, are valuable in predicting troponin positivity in COP cases.

Keywords:

Carbon monoxide poisoning, cardiac injury, systemic Immune-Inflammation index, monocyte to lymphocyte ratio, RDW to lymphocyte ratio, neutrophil to lymphocyte ratio, troponin,

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1. Dorey A, Scheerlinck P, Nguyen H, Albertson T. Acute and Chronic Carbon Monoxide Toxicity from Tobacco Smoking. Mil Med. 2020;185.
2. Chiew AL, Buckley NA. Carbon monoxide poisoning in the 21st century. Crit Care. 2014;18:1-8.
3. Iqbal S, Clower JH, Boehmer TK, Yip FY, Garbe P. Carbon monoxide-related hospitalizations in the U.S.: evaluation of a web-based query system for public health surveillance. Public Health Rep. 2010;125:423-32.
4. Brown MD, Byyny R, Diercks DB, Gemme SR, Gerardo CJ, Godwin SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning. Ann Emerg Med. 2017;69:98-107.e6.
5. Ng PCY, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med. 2018;13:223-29.
6. Cha YS, Cha KC, Kim OH, Lee KH, Hwang SO, Kim H. Features and predictors of myocardial injury in carbon monoxide poisoned patients. Emerg Med J. 2014;31:210-15.
7. Li B, Gao X, Wang W, Zhu B, Xiao Q. Effect of early intervention on short-term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning. ESC Hear Fail. 2022;9:1090-97.
8. Cha YS, Kim H, Hwang SO, Kim JY, Kim YK, Choi EH, et al. Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury. Clin Toxicol (Phila). 2016;54:481-87.
9. Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006;295:398-402.
10. Moon JM, Chun BJ, Cho YS, Lee SM. Diagnostic Value of Parameters Related to White Blood Cell Counts for Troponin I Elevation in CO Poisoning. Cardiovasc Toxicol. 2019;19:334-43.
11. Kaya H, Coskun A, Beton O, Kurt R, Yildirimli MK, Gul I. A cost effective parameter for predicting the troponin elevation in patients with carbon monoxide poisoning: red cell distribution width. Eur Rev Med Pharmacol Sci. 2016;20:2891-98.
12. Yaşar E, Bayramoğlu A. Systemic Immune-Inflammation Index as a Predictor of Microvascular Dysfunction in Patients With Cardiac Syndrome X. Angiology. Published online April 10, 2022.
13. Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15:625-32.
14. Thom SR, Bhopale VM, Han ST, Clark JM, Hardy KR. Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med. 2006;174:1239-48.
15. Schnittger V, Rosendahl K, Lind F, Palmblad J. Effects of carbon monoxide poisoning on neutrophil responses in patients treated with hyperbaric oxygen. J Investig Med. 2004;52:523-30.
16. Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018;52:131-36.
17. Ertekin B, Koçak S, Acar T, Öztürk E, Saltuk Demir L. Role of whole blood markers in carbon monoxide poisoning . Cukurova Med J Cukurova Med J. 2019;44:197-201.
18. Han YY, Wang Y, Zhao GQ, Yang JL, Wang L, Wang WZ. Relationship between neutrophil-to-lymphocyte ratio and myocardial injury induced by acute carbon monoxide poisoning. Zhonghua lao dong wei sheng zhi ye bing za zhi. 2018;36:362-64.
19. Wu J, Zhang X, Liu H, Guo N, Pan Q, Wang Y. RDW, NLR and RLR in predicting liver failure and prognosis in patients with hepatitis E virus infection. Clin Biochem. 2019;63:24-31.
20. Hannarici Z, Yilmaz A, Buyukbayram ME, Tekin SB, Bilici M. A novel prognostic biomarker for cutaneous malignant melanoma: red cell distribution width (RDW) to lymphocyte ratio. Melanoma Res. 2021;31:566-74.
21. Orozco SL, Canny SP, Hamerman JA. Signals governing monocyte differentiation during inflammation. Curr Opin Immunol. 2021;73:16-24.
22. Narasimhan PB, Marcovecchio P, Hamers AAJ, Hedrick CC. Nonclassical Monocytes in Health and Disease. Annu Rev Immunol. 2019;37:439-56.
23. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem. 2011;18:3226-33.
24. Mi J, Byeong M|, Chun J, Yong |, Cho S, Byeong C. The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication. Basic Clin Pharmacol Toxicol. 2019;124:500-10.
25. Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune–inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5:368.