Utility of brain CT for predicting delayed encephalopathy after acute carbon monoxide poisoning

Abstract

Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a serious complication that occurs several days or weeks after carbon monoxide (CO) intoxication. This study identified computed tomography (CT) findings in the prediction of DEACMP development. Adults with CO poisoning admitted to Beijing Chaoyang Hospital, Shenyang Ninth People's Hospital, Shanxi Second People's Hospital and Shandong Provincial Hospital in China from January 2013 to January 2016 were retrospectively analyzed. Baseline demographic and clinical characteristics were extracted from the medical records. Brain CT imaging was carried out within 24 h of admission, and an integrated CT score was calculated to semi-quantify lesion severity. Patients were followed-up for 6 months. Baseline characteristics and CT findings were compared among patients who developed DEACMP (DEACMP group) and those who did not (non-DEACMP group). The receiver operating characteristic (ROC) curve analysis was used to examine the utility of integrated CT score for predicting DEACMP. Among the 123 patients included in the analysis, 27 (22.0%) developed DEACMP. The DEACMP and non-DEACMP groups did not differ with regard to age, sex and carboxyhemoglobin (COHb) level at admission. However, compared with the non-DEACMP group, the patients in the DEACMP group had longer onset time of symptoms and duration of exposure to CO, higher acute physiology and chronic health evaluation-II (APACHE-II) score, lower Glasgow Coma Scale (GCS) score, and there was a higher proportion of patients with severe symptoms and brain CT abnormalities (81.5 vs. 51.0%; P<0.05). Integrated CT score in the DEACMP group was significantly higher than that in the non-DEACMP group (73.63 vs. 51.39; P<0.01). ROC curve was used to analyze the utility of integrated CT score in the prediction of DEACMP. The area under the ROC curve was 0.700 (95% confidence interval, 0.584–0.817; P<0.01). In conclusion, brain integrated CT score has the potential to identify DEACMP in patients.