Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Setting
2.2. Participant Selection
2.3. HBO Therapy Indication and Protocol
2.4. Clinical and Laboratory Assessments
2.5. Imaging Analysis
2.6. Statistical Analysis
2.7. Modeling
3. Result
4. Discussion
4.1. Incidence of DNS
4.2. Baseline Characteristics as Predictors for DNS
4.3. Laboratory Findings as Predictors for DNS
4.4. Brain Imaging as a Predictor for DNS
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Non-DNS (n = 124) | DNS (n = 30) | p-Value | |
---|---|---|---|
Age, year | 40 (29–50.3) | 44 (35–55) | 0.171 |
Male, n (%) | 82 (66.1) | 19 (63.3) | 0.940 |
BMI (kg/m2) | 23.3 (21.0–25.5) | 22.8 (21.0–25.4) | 0.769 |
Comorbidities (%) | |||
Hypertension | 9 (7.3) | 3 (10.0) | 0.902 |
Diabetes | 2 (1.6) | 0 (0) | >0.999 |
Vital signs | |||
Systolic BP, mmHg | 130 (113.5–140) | 130 (111.3–143.8) | 0.744 |
Diastolic BP, mmHg | 80 (70–90) | 80 (70–90) | 0.847 |
Heart rate, BPM | 92.5 (78–105) | 92 (78.5–100) | 0.734 |
Respiratory rate, BPM | 20 (18.8–20) | 20 (18–20) | 0.215 |
Body temperature, °C | 36.8 (36.5–37.2) | 36.9 (36.5–37.5) | 0.516 |
O2 saturation, % | 98 (97–98) | 97.5 (95–98) | 0.155 |
Initial GCS | 15 (12–15) | 12.5 (6.3–15) | 0.004 |
Exposure time, min | 150 (60–315) | 360 (90–480) | 0.072 |
Time from exposure to MRI, h | 32 (21–48) | 43 (24–78) | 0.175 |
Current smoking (%) | 60 (50) | 15 (51.7) | >0.999 |
Cause of exposure (%) | 0.124 | ||
Accidental | 41 (33.1) | 5 (16.7) | |
Intentional | 83 (66.9) | 25 (83.3) | |
Symptoms (%) | |||
Headache | 16 (12.9) | 2 (6.7) | 0.524 |
Loss of consciousness | 31 (25) | 9 (30) | 0.743 |
Chest pain | 2 (1.61) | 0 (0) | >0.999 |
Dizziness | 16 (12.9) | 1 (3.3) | 0.239 |
Dyspnea | 5 (4.0) | 0 (0) | 0.586 |
Laboratory findings | |||
COHb, % | 6.0 (2.8–11.8) | 9.3 (4.2–16.7) | 0.139 |
CRP, mg/dL | 0.11 (0.1–0.4) | 0.23 (0.1–0.8) | 0.077 |
Lactate, mg/dL | 2.1 (1.5–3.9) | 2.9 (1.8–4.1) | 0.690 |
Troponin I, ng/mL | 0.1 (0.1–0.3) | 0.1 (0.1–0.3) | 0.942 |
Ethanol, mg/dL | 1.5 (1.0–7.1) | 1.2 (0.7–4.2) | 0.222 |
Outcomes | |||
Onset of DNS, day | - | 27 (18–30) | - |
ABLM (%) | 31 (25) | 18 (60) | 0.001 |
No. (%) | |||
---|---|---|---|
Non-DNS | DNS | p-Value | |
Pattern | |||
Globus pallidus lesion | 16 (16.2) | 11 (36.7) | 0.031 |
Diffuse lesion | 13 (13.1) | 10 (33.3) | 0.024 |
Focal lesion | 5 (5.1) | 7 (23.3) | 0.007 |
Region | |||
Frontal | 5 (5.1) | 1 (3.3) | >0.999 |
Parietal | 5 (5.1) | 3 (10) | 0.387 |
Temporal | 2 (2.0) | 4 (13.3) | 0.026 |
Occipital | 2 (2.0) | 4 (13.3) | 0.026 |
Insular | 0 (0) | 0 (0) | |
Hippocampus | 3 (3.0) | 1 (3.3) | >0.99 |
Corpus callosum | 3 (3.0) | 2 (6.7) | 0.330 |
Splenium | 2 (2.0) | 1 (3.3) | 0.551 |
Internal capsule | 1 (1.0) | 0 (0) | >0.999 |
Centrum semiovale | 3 (3.0) | 1 (3.3) | >0.999 |
Periventricular white matter | 1 (1.0) | 2 (6.7) | 0.135 |
Globus pallidus | 16 (16.2) | 9 (30) | 0.157 |
Putamen | 1 (1.0) | 3 (10) | 0.039 |
Caudate | 1 (1.0) | 0 (0) | >0.999 |
Thalamus | 2 (2.0) | 1 (3.3) | 0.551 |
Midbrain | 0 (0) | 0 (0) | |
Pons | 0 (0) | 0 (0) | |
Medulla | 0 (0) | 0 (0) | |
Cerebellum | 4 (4.0) | 1 (3.3) | >0.999 |
Location | |||
Cortex | 6 (6.1) | 4 (13.3) | 0.240 |
White matter | 5 (5.1) | 9 (30) | <0.001 |
Deep nucleus | 24 (24.2) | 13 (43.3) | 0.073 |
Brainstem | 0 (0) | 0 (0) | |
Cerebellum | 4 (4.0) | 1 (3.3) | >0.999 |
Univariable Analysis OR (95% CI) | |
---|---|
COHb, % | 0.984 (0.943–1.027) |
Lactate, mg/dL | 0.992 (0.730–1.348) |
CRP, mg/dL | 1.055 (0.964–1.155) |
Troponin I, ng/mL | 1.164 (0.894–1.516) |
Initial GCS | 0.853 (0.771–0.944) |
Exposure time, min | 1.001 (1.000–1.002) |
ABLM | 3.804 (1.624–8.911) |
Globus pallidus (P) | 3.003 (1.203–7.501) |
Diffuse (P) | 3.308 (1.270–8.615) |
Focal (P) | 5.722(1.664–19.671) |
Temporal (R) | 7.462 (1.294–43.011) |
Occipital (R) | 7.462 (1.290–43.010) |
Putamen (R) | 10.889 (1.089–108.925) |
White matter (L) | 8.057 (2.448–26.516) |
Multivariable Analysis | ||||
---|---|---|---|---|
Model 1 OR (95% CI) | Model 2 OR (95% CI) | Model 3 OR (95% CI) | Model 4 OR (95% CI) | |
Initial GCS | 0.864 (0.760–0.983) | 0.882 (0.767–1.014) | 0.859 (0.755–0.978) | 0.849 (0.745–0.967) |
Exposure time, min | 1.002 (1.001–1.004) | 1.003 (1.001–1.004) | 1.003 (1.001–1.005) | 1.003 (1.001–1.004) |
ABLM | 2.242 (0.864–5.821) | |||
Globus pallidus (P) | 1.160 (0.364–3.695) | |||
Diffuse (P) | 2.728 (0.948–7.850) | |||
Focal (P) | 2.564 (0.527–12.477) | |||
Temporal (R) | 1.229 (0.109–13.868) | |||
Occipital (R) | 5.643 (0.440–72.543) | |||
Putamen (R) | 2.223 (0.115–43.033) | |||
White matter (L) | 6.741 (1.843–24.660) |
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Nah, S.; Choi, S.; Kim, H.B.; Lee, J.; Lee, S.-U.; Lee, Y.H.; Kim, G.W.; Han, S. Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study. Diagnostics 2020, 10, 698. https://doi.org/10.3390/diagnostics10090698
Nah S, Choi S, Kim HB, Lee J, Lee S-U, Lee YH, Kim GW, Han S. Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study. Diagnostics. 2020; 10(9):698. https://doi.org/10.3390/diagnostics10090698
Chicago/Turabian StyleNah, Sangun, Sungwoo Choi, Han Bit Kim, Jungbin Lee, Sun-Uk Lee, Young Hwan Lee, Gi Woon Kim, and Sangsoo Han. 2020. "Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study" Diagnostics 10, no. 9: 698. https://doi.org/10.3390/diagnostics10090698