Tarık Acar, Birsen Ertekin, Sedat Koçak, Esma Öztürk, Lütfi Saltuk Demir

Karbonmonoksit zehirlenmesi tanısında tam kan belirteçlerinin rolü

Amaç: Karbonmonoksit (CO) zehirlenmesi dünya çapındaki ölümcül intihar veya kazara zehirlenmelerin en yaygın nedenlerinden birisidir. Tanısında spesifik bir biyobelirteç yoktur. Bu sebeple çalışmada CO zehirlenmesinde tam kan parametreleri’nin rolü araştırılmıştır. Gereç ve Yöntem: Çalışmada 1 Ocak 2014 – 1 Ocak 2016 tarihleri arasında acil serviste CO zehirlenmesi tanısı alan ve dışlama kriterlerini sağlayan toplam 442 hasta retrospektif olarak incelendi. Hasta grubunun demografik özellikleri ve tam kan sonuçlarına hastane kayıt sisteminden ulaşıldı. Kontrol grubu acil servise benzer şikâyetler ile başvuran 100 hastadan oluşturuldu. Her iki grubun lökosit (WBC), kırmızı hücre dağılım genişliği (RDW), platelet, lenfosit, nötrofil, nötrofil-lenfosit oranı (NLR) ve platelet-lenfosit oranı (PLR) değerleri istatistiksel olarak karşılaştırıldı. Bulgular: Hasta ve kontrol grubu yaş ve cinsiyet bakımından birbirleri ile benzerdi. Hasta grubunun WBC, RDW, Platelet, Lenfosit, Nötrofil, NLR ve PLR değerleri kontrol grubu ile kıyaslandığında anlamlı derece yüksek bulundu. Ancak hasta yatış süreleri ile Glaskow Koma Skalası (GKS), karboksihemoglobin (COHb), RDW, NLR ve PLR düzeyleri arasında anlamlı bir korelasyon bulunmamıştır. Sonuç: Çalışmamız RDW, NLR ve PLR düzeylerinin CO zehirlenmesi tanısını öngörmede kullanılabilir bir biyobelirteç olma potansiyeli olduğunu düşündürmüştür.

Role of whole blood markers in carbon monoxide poisoning

Purpose: Carbon monoxide (CO) poisoning is one of themost common causes of fatal suicide or accidentalpoisoning worldwide. There is no specific biomarker in thediagnosis. Therefore, the role of whole blood parametersin CO poisoning was investigated.Material and Methods: A total of 442 patients diagnosedwith CO intoxication at the emergency departmentbetween January 1, 2014 and January 1, 2016 were includedin the study retrospectively. The demographiccharacteristics of the patient group and the complete bloodresults were obtained from the hospital registry system.The control group consisted of 100 patients presentingwith similar complaints to the emergency department.Leukocyte (WBC), red cell distribution width (RDW),platelet, lymphocyte, neutrophil, neutrophil lymphocyteratio (NLR) and platelet lymphocyte ratio (PLR) values ofboth groups were compared statistically.Results: The patient and control groups were similar inage and gender. The WBC, RDW, Platelet, Lymphocyte,Neutrophil, NLR and PLR levels of the patient group weresignificantly higher compared to the control group.However, there was no significant correlation betweenpatient admission time and Glaskow Coma Scale (GCS),carboxyhemoglobin (COHb), RDW, NLR and PLR levels.Conclusion: Our study suggested that RDW, NLR andPLR levels have potential to be a useful marker for thediagnosis of CO poisoning.

PDF

___

1. Raub JA, Mathiue-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning: a public health perspective. Toxicology 2000;145:1-14.
2. Weaver LK. Carbon monoxide poisoning. Crit Care Clin. 1999;15:297-317.
3. Zahorec. Ratio of neutrophil to lymphocyte counts - rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5– 14.
4. Sönmez O, Ertas‚ G, Bacaksız A, Tasal A, Erdogan E, Asoglu E et al. Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease, An observational study. Anadolu Kardiyol Derg. 2013;13:662-7.
5. Dundar ZD, Ergin M, Koylu R, Ozer R, Cander B, Gunaydin YK. Neutrophil-lymphocyte ratio in patients with pesticide poisoning. J Emerg Med. 2014;47:286-93.
6. Dündar Z.D, Köylü R, Ergin M, Günaydın Y.K, Özer R, Cander B. Prognostic value of red cell distribution width in patients with organophosphate poisoning. The Journal of Academic Emergency Medicine. 2015;14:65-9.
7. Vezzani G, Socias S, Bianco A, Paoli A, Caberti L, Antadori L et al. Inflammatory mediators and other biomarkers in co-intoxicated patients after hyperbaric oxygen therapy (Hbo2). Acta Medica Mediterranea. 2016;32:189.
8. Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clinics, diagnosis and treatments of heart involvement in carbon monoxide poisoning. Clin Biochem. 2012;45:1278-85.
9. Alonso JR, Cardellach F, López S, Casademont J, Miró O. Carbon monoxide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain. Pharmacol Toxicol. 2003;93:142-6.
10. Kulaksizoglu B, Kulaksizoglu S. Relationship between neutrophil lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia. Neuropsychiatr Dis Treat. 2016;12:1999-2005
11. de Jager CP, van Wijk PT, Mathoera RB, de JonghLeuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192.
12. Ayhan SS, Oztürk S, Erdem A, Ozlü MF, Ozyaşar M, Erdem K et al. Relation of neutrophil/lymphocyte ratio with the presence and severity of coronary artery ectasia. Turk Kardiyol Dern Ars. 2013;41:185–190.
13. Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11:445–52.
14. Kayrak M, Erdoğan Hİ, Solak Y, Akilli H, Gül EE, Yildirim O et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a retrospective study. Heart Lung Circ. 2014;23:56–62.
15. Akilli NB, Yortanlı M, Mutlu H, Günaydın YK, Koylu R, Akca HS et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med. 2014;32:1476-80.
16. Günaydın Y.K, Vural K, Ok MA, Katırcı Y, Kocaşaban D, Yiğit Y et al. Comparison of carbon monoxide poisonings originated from coal stove and natural gas and the evaluation of neutrophil/lymphocyte ratio. Dicle Medical Journal 2015;42:299-304.
17. Emektar E, Dağar S, Çorbacıoğlu Ş.K, Tandoğan M, Katırcı Y, Çevik Y. Karbonmonoksit zehirlenmelerinde sistemik inflamatuvar parametrelerin değerlendirilmesi. KÜ Tıp Fak Derg. 2019;21:1-8.
18. Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis 2015;39:179-85.
19. Sari I, Sunbul M, Mammadov C, Durmus E, Bozbay M, Kivrak T et al. Relation of neutrophil-to – lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiol Pol. 2015;73:1310-6.
20. Tousoulis D, Antoniades C, Koumallos N, Stefanadis C. Proinflammatory cytokines in acute coronary syndromes, from bench to bedside. Cytokine Growth Factor Rev. 2006;17:225-33.
21. Choi IS. Carbon monoxide poisoning: systemic manifestations and complications. J Korean Med Sci. 2001;16:253-61.
22. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011-23.
23. Ku NS, Kim HW, Oh HJ, Kim YC, Kim MH, Song JE et al. Red blood cell distribution width is an independent predictor of mortality in patients with gram-negative bacteremia. Shock. 2012;38:123-7.
24. Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013;31:687-9.
25. Harmanci O, Kav T, Sivri B. Red cell distribution width can predict intestinal atrophy in selected patients with celiac disease. J Clin Lab Anal. 2012;26:497–502
26. Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol. 2009;104:868–72.