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Abstract Summary Carbon monoxide (CO) poisoning is a major cause of morbidity and mortality worldwide. It is still a vital clinical issue of great concern to public health and toxicology. Early non-specific presentation makes diagnosis of CO poisoning difficult issue, therefore high level of suspicion and considering circumstances of poisoning is of crucial role. Acute CO toxicity is the result of a combination of tissue hypoxia secondary to carboxyhemoglobin formation that has > 250 times affinity to hemoglobin than oxygen together with direct CO-mediated damage at a cellular level. Delayed neurological sequelae (DNS) are the most frequent form of COrelated morbidity. They include cognitive impairments, memory disturbances, affective disorders and abnormal neurological signs that developed between 2- 40 days CO poisoning. Therefore, its prevention and early prediction after acute CO is now the main goal of treatment. There are limited studies in the literature that aimed to assess the role of pentraxin 3, ischemia-modified albumin and myeloperoxidase enzyme in prediction of outcome and severity of acute CO poisoning. Therefore, there is an insisting need for novel promising biomarkers that can access the severity and outcome of CO poisoning. This study aimed to assess the role of pentraxin 3, ischemia-modified albumin and myeloperoxidase in predicting acute CO poisoning-related outcome. The study herein is a prospective observational cohort study that was carried out following approval of the medical research ethical committee of Faculty of Medicine, Tanta University on 55 acutely CO-poisoned patients admitted to the Tanta Poison Control center (Emergency Hospital, Tanta University) and 55 non-exposed healthy volunteers (control group) during the period from the start of December 2016 to the end of November 2017. Moreover, patients were followed up at 3 and 6 months following discharge from hospital at neuropsychiatry hospital for detection of delayed neuropsychological sequelae (DNS). Written informed consent was obtained from patients or from their guardians. Patients with the following criteria were excluded from the study: When diagnosis of carbon monoxide (CO) poisoning is not definite. Expected rise in levels of the studied markers as presence of co ingestion, ischemic heart diseases, chronic obstructive pulmonary diseases, smoking history (current or smoking cessation since less than 2 months), pregnancy and previous history of recent CO exposure. Patients with hypoproteinemia (The normal range is 3.5 to 5.5 g/dL). Patients with chronic disease such as: diabetes, hypertension, bronchial asthma, hepatic, renal, cardiovascular diseases that may affect the oucome. Patients who received medical treatment in another health institution before admission. Patients aged less than 18 years. The enrolled subjects were subjected to the following: Personal history taking: including (Age, gender, residence, occupation and education) is obtained including. Full medical history: Smoking, chronic diseases, medications and allergy. Full toxicological history: Including (source, duration and place of exposure t CO, delay time before arrival to medical facility, number of persons involved and presenting symptoms of CO poisoning.Clinical assessment: All patients were generally examined on admission to obtain vital data (blood pressure, pulse, respiratory rate and temperature) and oxygen saturation. Consciousness level by the Glasgow Coma Scale and pupil size were assessed immediately at presentation. Cardiovascular, respiratory and genitourinary systems and skin were also examined and any abnormalities were recorded. Follow up: Assessment of patient’s neurological and psychological outcome was done initially after patient regain stable level of consciousness and then at 3 and 6 weeks after carbon monoxide (CO) poisoning as all patients were invited for follow up visits at neuropsychiatry hospital for detection of delayed neuropsychiatric syndrome. Laboratory investigations: Blood samples underwent analysis for routine laboratory measurement of arterial blood gases, serum electrolytes (Na and k), random blood glucose, urea, creatinine and liver enzymes ALT and AST. Carboxyhemoglobin level on admission was also measured by Rad.57 Signal Extraction Pulse CO-Oximeter device. On admission levels of Pentraxin 3 (ng/ml) in plasma and myeloperoxidase (pg/ml) in serum were measured using ELISA Kit purchased from (Chongqing Biospes company). Spectrophotometric assay of on admission serum levels of ischemia-modified albumin (ABSU) was done. The twelve-lead ECGs were recorded for each of the patient on admission. Two-dimensional echocardiography was done to patients suspected withmyocardial injury in ECG as soon as possible after admission It was done at Cardiovascular Medicine Department, Tanta University Hospitals. Outcome assessment: Duration of hospital stay, number of hyperbaric oxygen sessions and need for assisted or mechanical ventilation were also recorded. The current study revealed that delayed neurological sequelae (DNS) were common complications after acute carbon monoxide (CO) poisoning as they were developed in 49.1% of the studied cases, whereas 41.8% of patients developed no complications and 9.1% died. The occurrence of memory disturbances was the most common DNS after acute CO intoxication (12.7%), followed by speech difficulties (10.9%), while the least recorded complication was depression (1.8%). It was observed that, the age group (18 - 28 years) was the commonest involved in all studied groups. There were insignificant differences between the studied CO-poisoned patients and their control group as regards their demographic data. |