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KMID : 1100620200070030183
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Clinical and Experimental Emergency Medicine
2020 Volume.7 No. 3 p.183 ~ p.189
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Diagnostic performance and optimal cut-off values of cardiac biomarkers for predicting cardiac injury in carbon monoxide poisoning
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Park Jun-Hwan
Heo Ran
Kang Hyung-Goo
Oh Jae-Hoon
Lim Tae-Ho
Ko Byuk-Sung
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Abstract
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Objective: This study aimed to compare the diagnostic performance of cardiac biomarkers and to evaluate the optimal cut-off values for echocardiographic cardiac injury prediction in patients with carbon monoxide (CO) poisoning.
Methods: This retrospective observational cohort study included adult patients with acute CO poisoning. Patients who did not undergo transthoracic echocardiography, which was used to define patients with cardiac injury (ejection fraction <55%), were excluded. The area under the curve was used to evaluate diagnostic performance for cardiac injury prediction. Mann-Whitney U, chi-square, and Fisher exact tests were used to analyze data.
Results: After excluding the 27 patients who did not undergo echocardiography, 114 patients were included in the study. Fifteen (13.2%) patients had cardiac injury. The area under the curve values for the B-type natriuretic peptide, creatine kinase-myocardial band, and troponin I were 0.711 (95% confidence interval [CI], 0.527?0.895; P=0.011), 0.766 (95% CI, 0.607?0.926; P=0.001), and 0.801 (95% CI, 0.647?0.955; P<0.001), respectively, with optimal cut-off values of 330 pg/mL, 10.1 ng/mL, and 0.455 ng/mL, respectively. The sensitivity, specificity, and positive and negative predictive values of troponin I were 67%, 91%, 53%, and 95%, respectively.
Conclusion: Troponin I showed the best diagnostic performance for predicting cardiac injury in patients with CO poisoning. A cut-off value of 0.455 ng/mL appeared optimal for cardiac injury prediction. However, further studies on cardiac biomarkers and other diagnostic tools in CO poisoning are needed given the low sensitivity of troponin I.
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KEYWORD
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Carbon monoxide, Poisoning, Echocardiography
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