Sinem DOĞRUYOL, İlker AKBAŞ, Erdal TEKİN

Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?

Amaç: Bu çalışmanın amacı karbonmonoksit zehirlenmesi nedeniyle acil servise başvurmuş olan olguların başvuru anındaki plazma laktat düzeyi ile COHb düzeyleri arasında anlamlı bir ilişki olup olmadığını değerlendirmektir. Gereç ve Yöntem: Retrospektif-kesitsel bu çalışmada, 01.01.2013-01.01.2017 tarihleri arasında acil servise başvurmuş olgular arasından, hastane veri sisteminde ‘Karbonmonoksitin toksik etkisi’ tanı kodu mevcut olanlar incelendi. Hastalar karboksihemoglobin düzeylerine göre Grup 1 (%10-%20 arası) ve Grup 2 (%20 ve üstü) şeklinde sınıflandırıldı. Bulgular: Çalışmaya toplam 404 olgu dahil edildi. Tüm olgular için ortalama karboksihemoglobin düzeyi %21,2±8 olup, Grup 1 için ortalama %14,6±3, Grup 2 için ise %27,8±6 olarak hesaplandı. İki grup arasındaki bu fark istatistiksel olarak anlamlıydı (ortalama fark, 13,2; %95 GA= 12,198-14,157) (p<0,001). Grup 2’de normalin üstünde laktat değerleri tespit edilen olgu sayısı, Grup 1’e göre fazlaydı (p<lt;0,001). İki maruziyet grubu arasında laktat değerleri açısından anlamlı fark tespit edildi (p<0,001). Karboksihemoglobin düzeyleri ile laktat seviyeleri arasında korelasyon mevcuttu (r=0,601, p<0,001). Ciddi maruziyet (Grup 2) tanısında laktat düzeylerinin değerliliğini araştırmak için oluşturulan ROC analizinde, AUC 0,791 olarak hesaplandı (95% güven aralığında , 0.748–0.835; p<0,001; Şekil 1). Sonuç: Karbonmonoksit zehirlenmesi olgularının değerlendirilmesinde, plazma laktat düzeyinin bir belirteç olarak kullanılabileceği konusu hala tartışmalıdır. Çalışmamız, saptamış olduğumuz anlamlı sonuçlara dayanarak, karboksihemoglonin düzeyi ile korele bir yükseliş gösterdiğinden plazma laktat düzeylerinin olguların sınıflandırılmasında kullanılabileceğini göstermiştir.

Anahtar Kelimeler:

Karboksihemoglobin, Karbonmonoksit, Laktat, Zehirlenme

Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?

Objectives: The aim of this study was to determine whether there was a significant relationship between carboxyhemoglobin levels and plasma lactate levels at the time of admission in patients who had been admitted to the emergency department due to carbon monoxide intoxication.Materials ad Methods: In this retrospective-cross-sectional study, patients diagnosed with toxic effects of carbon monoxide were evaluated among the patients admitted to the emergency department between 01.01.2013-01.01.2017. Blood gas data obtained from the peripheral artery in the first 30 minutes of patients’ admission to the emergency department were examined. Patients were classified as Group 1 (10% -20%) and Group 2 (20% and above) according to their carboxyhemoglobin levels.Results: A total of 404 patients were included in the study. The mean carboxyhemoglobin level was 21.2 ± 8% for all cases and 14.6 ± 3% for Group 1 and 27.8 ± 6% for Group 2. The difference between the two groups was statistically significant (mean difference 13.2; 95% CI = 12,198-14,157) (p <0.001). The number of patients with lactate levels above normal in Group 2 was higher than Group 1 (p <0.001). There was a significant difference in lactate levels between two exposure groups (p <0.001). At the same time, when all parameters were evaluated, there was a correlation between carboxyhemoglobin levels and lactate levels (r = 0,601, p <0,001). In the ROC analysis to determine the value of lactate levels in the diagnosis of severe exposure (Group 2), AUC was calculated as 0,791 (95% confidence interval, 0.748-0.835; p <0.001; Figure 1). The positive predictive value for lactate level 3 mmol/L was 88% and the negative predictive value was 63% and this level could be used as cut-off value.Conclusion: In the evaluation of cases of carbon monoxide poisoning, the question of whether plasma lactate level can be used as a marker is still being discussed. Based on the significant results that we found in our study, plasma lactate levels ,which is correlated with carboxyhemoglobin levels, may be helpful in the classification and evaluation of patients with carbon monoxide intoxication.

Keywords:

Carboxyhemoglobin, Carbon monoxide, Lactate, Poisoning,

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