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Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning

IMPORTANCE: Preventing neurocognitive sequelae is a major goal of treating acute carbon monoxide (co) poisoning. There is a lack of reliable score systems exist for assessing the probability of these sequelae. OBJECTIVE: To develop and validate a novel clinical scoring system for predicting poor neu...

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Autores principales: Kim, Sung Hwa, Lee, Yoonsuk, Kang, Soo, Paik, Jin Hui, Kim, Hyun, Cha, Yong Sung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073567/
https://www.ncbi.nlm.nih.gov/pubmed/35511176
http://dx.doi.org/10.1001/jamanetworkopen.2022.10552
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author Kim, Sung Hwa
Lee, Yoonsuk
Kang, Soo
Paik, Jin Hui
Kim, Hyun
Cha, Yong Sung
author_facet Kim, Sung Hwa
Lee, Yoonsuk
Kang, Soo
Paik, Jin Hui
Kim, Hyun
Cha, Yong Sung
author_sort Kim, Sung Hwa
collection PubMed
description IMPORTANCE: Preventing neurocognitive sequelae is a major goal of treating acute carbon monoxide (co) poisoning. There is a lack of reliable score systems exist for assessing the probability of these sequelae. OBJECTIVE: To develop and validate a novel clinical scoring system for predicting poor neurocognitive outcomes after acute co poisoning. DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included derivation and validation cohorts based on consecutive patient data prospectively collected at university hospitals from January 2006 to July 2021 in Wonju, Republic of Korea, and from August 2016 to June 2020 in Incheon, Republic of Korea. Participants included individuals aged 16 years or older admitted with co poisoning. Data were analyzed from October 2021 to January 2022. EXPOSURES: Clinical and laboratory variables. MAIN OUTCOMES AND MEASURES: The outcome of interest was neurocognitive sequelae at 4 weeks after co poisoning. Logistic regression models were used to identify predictors of poor neurocognitive outcomes in the derivation cohort. Outcomes were assessed using the Global Deterioration Scale [GDS] at 1-month after co exposure and classified as good (1-3 points) or poor (4-7 points). RESULTS: A total of 1282 patients (median [IQR] age, 47.0 [35.0-59.0] years; 810 [63.2%] men) were assessed, including 1016 patients in the derivation cohort and 266 patients in the validation cohort. The derivation cohort included 126 patients (12.4%) with poor GDS scores. Among 879 patients in the derivation cohort with 1-year follow-up data, 757 (86.1%) had unchanged GDS scores, 102 (11.6%) had improved GDS scores, and 20 (2.3%) had worsened GDS scores. In the final prediction model, age older than 50 years (1 point), Glasgow Coma Scale score of 12 or less (1 point), shock (1 point), serum creatine kinase level greater than 320 U/L at emergency department presentation (1 point), and no use of hyperbaric oxygen therapy (1 point) remained factors significantly associated with worse outcome; therefore, this scoring system was called COGAS (creatine kinase, hyperbaric oxygen therapy, Glasgow Coma Scale, age, shock). Area under the receiver operating characteristic curve for COGAS score was 0.862 (95% CI, 0.828-0.895) for the derivation cohort and 0.870 (95% CI, 0.779-0.961) for the validation cohort. CONCLUSIONS AND RELEVANCE: These findings suggest that assessing the COGAS score during the early phase of co poisoning may help identify patients at risk of poor neurocognitive sequelae.
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spelling pubmed-90735672022-05-18 Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning Kim, Sung Hwa Lee, Yoonsuk Kang, Soo Paik, Jin Hui Kim, Hyun Cha, Yong Sung JAMA Netw Open Original Investigation IMPORTANCE: Preventing neurocognitive sequelae is a major goal of treating acute carbon monoxide (co) poisoning. There is a lack of reliable score systems exist for assessing the probability of these sequelae. OBJECTIVE: To develop and validate a novel clinical scoring system for predicting poor neurocognitive outcomes after acute co poisoning. DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included derivation and validation cohorts based on consecutive patient data prospectively collected at university hospitals from January 2006 to July 2021 in Wonju, Republic of Korea, and from August 2016 to June 2020 in Incheon, Republic of Korea. Participants included individuals aged 16 years or older admitted with co poisoning. Data were analyzed from October 2021 to January 2022. EXPOSURES: Clinical and laboratory variables. MAIN OUTCOMES AND MEASURES: The outcome of interest was neurocognitive sequelae at 4 weeks after co poisoning. Logistic regression models were used to identify predictors of poor neurocognitive outcomes in the derivation cohort. Outcomes were assessed using the Global Deterioration Scale [GDS] at 1-month after co exposure and classified as good (1-3 points) or poor (4-7 points). RESULTS: A total of 1282 patients (median [IQR] age, 47.0 [35.0-59.0] years; 810 [63.2%] men) were assessed, including 1016 patients in the derivation cohort and 266 patients in the validation cohort. The derivation cohort included 126 patients (12.4%) with poor GDS scores. Among 879 patients in the derivation cohort with 1-year follow-up data, 757 (86.1%) had unchanged GDS scores, 102 (11.6%) had improved GDS scores, and 20 (2.3%) had worsened GDS scores. In the final prediction model, age older than 50 years (1 point), Glasgow Coma Scale score of 12 or less (1 point), shock (1 point), serum creatine kinase level greater than 320 U/L at emergency department presentation (1 point), and no use of hyperbaric oxygen therapy (1 point) remained factors significantly associated with worse outcome; therefore, this scoring system was called COGAS (creatine kinase, hyperbaric oxygen therapy, Glasgow Coma Scale, age, shock). Area under the receiver operating characteristic curve for COGAS score was 0.862 (95% CI, 0.828-0.895) for the derivation cohort and 0.870 (95% CI, 0.779-0.961) for the validation cohort. CONCLUSIONS AND RELEVANCE: These findings suggest that assessing the COGAS score during the early phase of co poisoning may help identify patients at risk of poor neurocognitive sequelae. American Medical Association 2022-05-05 /pmc/articles/PMC9073567/ /pubmed/35511176 http://dx.doi.org/10.1001/jamanetworkopen.2022.10552 Text en Copyright 2022 Kim SH et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Kim, Sung Hwa
Lee, Yoonsuk
Kang, Soo
Paik, Jin Hui
Kim, Hyun
Cha, Yong Sung
Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title_full Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title_fullStr Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title_full_unstemmed Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title_short Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning
title_sort derivation and validation of a score for predicting poor neurocognitive outcomes in acute carbon monoxide poisoning
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073567/
https://www.ncbi.nlm.nih.gov/pubmed/35511176
http://dx.doi.org/10.1001/jamanetworkopen.2022.10552
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