Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning
Abstract
:1. Introduction
2. Experimental Section
2.1. Data Source
2.2. Identification of Patients with COP
2.3. Definitions of Variables
2.4. Comparison of the Risk for NS Between the Two Cohorts and Independent Predictors for NS
2.5. Ethics Statement
2.6. Data Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
HBOT | hyperbaric oxygen therapy |
NS | neurological sequelae |
COP | carbon monoxide poisoning |
NBO | normobaricoxygen |
COPD | chronic pulmonary obstructive disease |
HIV | Human Immunodeficiency Virus |
AHR | adjusted hazard ratio |
CI | confidence interval |
CO | carbon monoxide |
NPD | Nationwide Poisoning Database |
NHIRD | National Health Insurance Research Database |
ICD-9-CM | International Classification of Diseases, Ninth Revision, Clinical Modification |
COHb | carboxyhemoglobin |
IRR | incidence rate ratio |
ATA | atmosphere absolute |
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Variable | Total Patients n = 24,046 (100.0) | Without HBOT n = 17,253 (71.8) | With HBOT n = 6793 (28.2) | p-Value * |
---|---|---|---|---|
Age (years) | 35.7 ± 16.6 | 36.1 ± 17.2 | 34.8 ± 14.8 | <0.001 |
Age subgroup (years) | ||||
<20 | 3382 (14.1) | 2509 (14.5) | 873 (12.9) | <0.001 |
20−34 | 8987 (37.4) | 6221 (36.1) | 2766 (40.7) | |
35−50 | 7293 (30.3) | 5148 (29.8) | 2145 (31.6) | |
51−64 | 2996 (12.5) | 2223 (12.9) | 773 (11.4) | |
≥65 | 1388 (5.8) | 1152 (6.7) | 236 (3.5) | |
Sex | ||||
Female | 12,062 (50.2) | 8653 (50.2) | 3409 (50.2) | 0.966 |
Male | 11,984 (49.8) | 8600 (49.9) | 3384 (49.8) | |
Underlying comorbidity | ||||
Hypertension | 2815 (11.7) | 2216 (12.8) | 599 (8.8) | <0.001 |
Diabetes | 1499 (6.2) | 1137 (6.6) | 362 (5.3) | <0.001 |
Chronic obstructive pulmonary disease | 385 (1.6) | 320 (1.9) | 65 (1.0) | <0.001 |
Hyperlipidemia | 1967 (8.2) | 1486 (8.6) | 481 (7.1) | <0.001 |
Malignancy | 643 (2.7) | 499 (2.9) | 144 (2.1) | <0.001 |
Coronary artery disease | 1358 (5.7) | 1067 (6.2) | 291 (4.3) | <0.001 |
Congestive heart failure | 392 (1.6) | 326 (1.9) | 66 (1.0) | <0.001 |
Liver disease | 3307 (13.8) | 2428 (14.1) | 879 (12.9) | 0.022 |
Renal disease | 2445 (10.2) | 1804 (10.5) | 641 (9.4) | 0.013 |
Connective tissue disease | 208 (0.9) | 146 (0.9) | 62 (0.9) | 0.616 |
HIV infection | 61 (0.3) | 46 (0.3) | 15 (0.2) | 0.525 |
Alcoholism | 861 (3.6) | 668 (3.9) | 193 (2.8) | <0.001 |
Monthly income (NTD) | ||||
<19,999 | 17,622 (73.3) | 12,670 (73.4) | 4952 (72.9) | 0.156 |
20,000−39,999 | 5122 (21.3) | 3629 (21.0) | 1493 (22.0) | |
≥40,000 | 1302 (5.4) | 954 (5.5) | 348 (5.1) | |
Concomitant condition | ||||
Suicide | 4763 (19.8) | 2642 (15.3) | 2121 (31.2) | <0.001 |
Drug poisoning | 245 (1.0) | 187 (1.1) | 58 (0.9) | 0.110 |
Acute respiratory failure | 1737 (7.2) | 1077 (6.2) | 660 (9.7) | <0.001 |
Acute myocardial injury | 54 (0.2) | 39 (0.2) | 15 (0.2) | 0.939 |
Acute hepatitis | 52 (0.2) | 39 (0.2) | 13 (0.2) | 0.602 |
Acute renal failure | 299 (1.2) | 167 (1.0) | 132 (1.9) | <0.001 |
Variable | With HBOT | Without HBOT (reference) | Crude HR (95% CI) | AHR (95% CI) * | IRR (95% CI) | ||||
---|---|---|---|---|---|---|---|---|---|
Case | PY | Rate | Case | PY | Rate | ||||
Overall analysis | 3043 | 20,765.3 | 146.5 | 5992 | 64,832.7 | 92.4 | 1.5 (1.4–1.6) | 1.4 (1.4–1.5) | – |
Stratified analysis | |||||||||
NS subgroup | |||||||||
Degenerative diseases of the central nervous system | 657 | 28,291.9 | 23.2 | 1197 | 80,595.3 | 14.9 | 1.5 (1.3–1.6) | 1.5 (1.3–1.6) | – |
Psychiatric diseases | 2076 | 23,642.8 | 87.8 | 4145 | 69,828.3 | 59.3 | 1.4 (1.3–1.5) | 1.3 (1.2–1.4) | – |
Other diseases of the nervous system | 1461 | 25,357.5 | 57.6 | 2619 | 75,099.8 | 34.9 | 1.6 (1.5–1.7) | 1.5 (1.4–1.6) | – |
Age (years) | |||||||||
<20 | 217 | 3851.3 | 56.3 | 465 | 12,736.9 | 36.5 | 1.5 (13–1.8) | 1.4 (1.2–1.7) | – |
20−34 | 1243 | 8449.4 | 147.1 | 2170 | 24,724.1 | 87.8 | 1.6 (1.5–1.7) | 1.4 (1.3–1.5) | – |
35−50 | 1060 | 6093.6 | 174.0 | 1999 | 18,418.8 | 108.5 | 1.5 (1.4–1.6) | 1.4 (1.3–1.5) | – |
51−64 | 393 | 1890.4 | 207.9 | 871 | 6226.9 | 139.9 | 1.5 (1.3–1.6) | 1.4 (1.3–1.6) | – |
≥65 | 130 | 480.6 | 270.5 | 487 | 2726.2 | 178.6 | 1.5 (1.2–1.8) | 1.4 (1.2–1.7) | – |
Sex | |||||||||
Female | 1566 | 10,574.5 | 148.1 | 3235 | 33,324.4 | 97.1 | 1.5 (1.4–1.6) | 1.6 (1.3–1.4) | – |
Male | 1477 | 10,190.8 | 144.9 | 2757 | 31,508.3 | 87.5 | 1.6 (1.5–1.7) | 1.5 (1.4–1.6) | – |
Underlying comorbidity | |||||||||
Hypertension | 309 | 1374.7 | 224.8 | 925 | 5416.5 | 170.8 | 1.3 (1.1–1.5) | 1.3 (1.1–1.5) | – |
Diabetes | 167 | 852.4 | 195.9 | 437 | 2676.5 | 163.3 | 1.2 (1.0–1.4) | 1.2 (1.0–1.4) | – |
Chronic obstructive pulmonary disease | 42 | 104.8 | 400.7 | 129 | 730.3 | 176.7 | 2.1 (1.4–2.9) | 2.1 (1.4–3.0) | – |
Hyperlipidemia | 257 | 1008.0 | 255.0 | 577 | 3700.7 | 155.9 | 1.6 (1.4–1.8) | 1.5 (1.3–1.8) | – |
Malignancy | 72 | 258.7 | 278.3 | 184 | 989.0 | 186.1 | 1.4 (1.1–1.9) | 1.4 (1.1–1.9) | – |
Coronary artery disease | 148 | 621.3 | 238.2 | 452 | 2490.7 | 181.5 | 1.3 (1.1–1.6) | 1.3 (1.0–1.5) | – |
Congestive heart failure | 33 | 130.6 | 252.7 | 122 | 616.9 | 197.8 | 1.3 (0.9–1.9) | 1.5 (1.0–2.3) | – |
Liver disease | 446 | 2059.1 | 216.6 | 1037 | 6424.1 | 161.4 | 1.3 (1.2–1.5) | 1.3 (1.1–1.4) | – |
Renal disease | 319 | 1490.7 | 214 | 707 | 4975.9 | 142.1 | 1.5 (1.3–1.7) | 1.4 (1.2–1.6) | – |
Connective tissue disease | 38 | 121.9 | 311.7 | 55 | 345.1 | 159.4 | 1.9 (1.3–2.9) | 2.0 (1.2–3.2) | – |
HIV infection | 9 | 29.2 | 308.3 | 13 | 118.5 | 109.7 | 2.5 (1.1–5.9) | 10.3 (2.3–45.8) | – |
Alcoholism | 115 | 381.3 | 301.6 | 308 | 1574.3 | 195.7 | 1.5 (1.2–1.9) | 1.6 (1.2–1.9) | – |
Monthly income (NTD) | |||||||||
<19,999 | 2322 | 15,060.2 | 154.2 | 4573 | 47,295.3 | 96.7 | 1.5 (1.4–1.6) | 1.4 (1.4–1.5) | – |
20,000−39,999 | 586 | 4516.8 | 129.7 | 1142 | 13,501.0 | 84.6 | 1.5 (1.3–1.6) | 1.4 (1.2–1.5) | – |
≥40,000 | 135 | 1188.4 | 113.6 | 277 | 4036.4 | 68.6 | 1.6 (1.3–1.9) | 1.5 (1.2–1.9) | – |
Suicide | |||||||||
Yes | 1181 | 5664.8 | 208.5 | 1305 | 8639.4 | 151.1 | 1.3 (1.2–1.4) | 1.3 (1.2–1.4) | – |
No | 1862 | 15,100.5 | 123.3 | 4687 | 56,193.3 | 83.4 | 1.4 (1.3–1.5) | 1.5 (1.4–1.5) | – |
Drug poisoning | |||||||||
Yes | 33 | 116.0 | 284.4 | 81 | 620.2 | 130.6 | 1.9 (1.2–2.8) | 1.6 (1.0–2.6) | – |
No | 3010 | 20,649.3 | 145.8 | 5911 | 64,212.5 | 92.1 | 1.5 (1.4–1.6) | 1.4 (1.4–1.5) | – |
Acute respiratory failure | |||||||||
Yes | 429 | 1268.5 | 338.2 | 440 | 2281.6 | 192.9 | 1.6 (1.4–1.8) | 1.5 (1.3–1.8) | – |
No | 2614 | 19,496.8 | 134.1 | 5552 | 62,551.1 | 88.8 | 1.4 (1.4–1.5) | 1.4 (1.3–1.5) | – |
Follow-up period | |||||||||
<2 weeks | 597 | 245.2 | 2434.7 | 579 | 620.5 | 933.1 | 2.6 (2.3–2.9) | 2.4 (2.1–2.7) | 2.6 (2.3–2.9) |
2–4 weeks | 283 | 290.6 | 973.8 | 308 | 733.9 | 419.7 | 1.7 (1.5–2.0) | 1.6 (1.4–1.9) | 2.3 (2.0–2.7) |
1−6 months | 682 | 2279.1 | 299.2 | 1010 | 6162.6 | 163.9 | 1.8 (1.6–2.0) | 1.6 (1.4–1.7) | 1.8 (1.7–2.0) |
6−12 months | 283 | 2871.4 | 98.6 | 537 | 7661.6 | 70.1 | 1.7 (0.9–1.2) | 1.0 (0.8–1.1) | 1.4 (1.2–1.6) |
1−2 years | 306 | 5422.4 | 56.4 | 816 | 15,028.2 | 54.3 | 1.0 (0.9–1.2) | 0.9 (0.8–1.1) | 1.0 (0.9–1.2) |
2−4 years | 416 | 10,066.8 | 41.3 | 1121 | 28,572.7 | 39.2 | 1.0 (0.9–1.1) | 0.9 (0.8–1.1) | 1.1 (0.9–1.2) |
≥4 years | 476 | 20,765.3 | 22.9 | 1621 | 64,832.7 | 25.0 | 1.1 (0.9–1.2) | 1.0 (0.9–1.2) | 0.9 (0.8–1.0) |
Patients with COP Who Received HBOT | Patients with COP Who Did Not Receive HBOT | |||
---|---|---|---|---|
Variable | Crude HR (95% CI) | AHR (95% CI) * | Crude HR (95% CI) | AHR (95% CI) * |
Age (years) | ||||
<20 | 1 | 1 | 1 | 1 |
20−34 | 2.4 (2.1–2.6) | 2.3 (2.1–2.5) | 2.3 (2.0–2.7) | 2.2 (1.9–2.5) |
35−50 | 2.9 (2.6–3.2) | 2.6 (2.3–2.9) | 2.7 (2.3–3.1) | 2.4 (2.0–2.8) |
51−64 | 3.5 (3.1–3.9) | 2.8 (2.5–3.2) | 3.0 (2.5–3.5) | 2.6 (2.2–3.1) |
≥65 | 4.3 (3.8–4.9) | 3.4 (2.9–3.9) | 3.5 (2.8–4.3) | 2.9 (2.2–3.7) |
Sex | ||||
Female | 1 | 1 | 1 | 1 |
Male | 0.9 (0.9–0.9) | 1.2 (1.2–1.3) | 1.0 (0.9–1.1) | 1.1 (1.0–1.2) |
Monthly income (NTD) | ||||
<19,999 | 1.4 (1.2–1.6) | 1.4 (1.3–1.6) | 1.3 (1.1–1.6) | 1.3 (1.1–1.6) |
20,000−39,999 | 1.2 (1.1–1.4) | 1.2 (1.0–1.3) | 1.1 (0.9–1.3) | 1.1 (0.9–1.3) |
≥40,000 | 1 | 1 | 1 | 1 |
Underlying comorbidity | ||||
Hypertension | 1.8 (1.7–1.9) | 1.2 (1.1–1.3) | 1.4 (1.2–1.6) | 1.0 (0.9–1.2) |
Diabetes | 1.6 (1.5–1.8) | 1.0 (0.9–1.1) | 1.2 (1.0–1.4) | 0.7 (0.6–0.9) |
Chronic obstructive pulmonary disease | 1.7 (1.4–2.0) | 1.0 (0.8–1.2) | 2.0 (1.5–2.7) | 1.5 (1.1–2.1) |
Hyperlipidemia | 1.6 (1.5–1.7) | 1.0 (0.9–1.1) | 1.5 (1.3–1.7) | 1.3 (1.1–1.5) |
Malignancy | 1.8 (1.5–2.0) | 1.2 (1.0–1.4) | 1.5 (1.2–1.9) | 1.1 (0.9–1.4) |
Coronary artery disease | 1.8 (1.7–2.0) | 1.1 (1.0–1.2) | 1.4 (1.2–1.6) | 1.0 (0.8–1.2) |
Congestive heart failure | 1.8 (1.5–2.1) | 1.0 (0.8–1.2) | 1.4 (1.0–2.0) | 0.9 (0.6–1.3) |
Liver disease | 1.8 (1.6–1.9) | 1.3 (1.2–1.4) | 1.4 (1.2–1.5) | 1.1 (0.9–1.2) |
Renal disease | 1.5 (1.4–1.6) | 1.1 (1.0–1.2) | 1.3 (1.2–1.5) | 1.1 (1.0–1.2) |
Connective tissue disease | 1.6 (1.2–2.1) | 1.1 (0.9–1.5) | 1.7 (1.3–2.4) | 1.3 (1.0–1.8) |
HIV infection | 1.1 (0.6–1.9) | 1.0 (0.6–1.7) | 1.7 (0.9–3.2) | 1.2 (0.6–2.3) |
Alcoholism | 1.9 (1.7–2.2) | 1.4 (1.2–1.5) | 1.7 (1.4–2.0) | 1.3 (1.1–1.6) |
Concomitant condition | ||||
Suicide | 1.8 (1.7–1.9) | 1.5 (1.4–1.6) | 1.6 (1.5–1.7) | 1.4 (1.3–1.5) |
Drug poisoning | 1.4 (1.1–1.7) | 1.2 (1.0–1.5) | 1.6 (1.2–2.3) | 1.5 (1.1–2.1) |
Acute respiratory failure | 2.0 (1.8–2.2) | 1.6 (1.4–1.7) | 2.1 (1.9–2.3) | 1.7 (1.6–1.9) |
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Huang, C.-C.; Ho, C.-H.; Chen, Y.-C.; Hsu, C.-C.; Wang, Y.-F.; Lin, H.-J.; Wang, J.-J.; Guo, H.-R. Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning. J. Clin. Med. 2018, 7, 349. https://doi.org/10.3390/jcm7100349
Huang C-C, Ho C-H, Chen Y-C, Hsu C-C, Wang Y-F, Lin H-J, Wang J-J, Guo H-R. Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning. Journal of Clinical Medicine. 2018; 7(10):349. https://doi.org/10.3390/jcm7100349
Chicago/Turabian StyleHuang, Chien-Cheng, Chung-Han Ho, Yi-Chen Chen, Chien-Chin Hsu, Yi-Fong Wang, Hung-Jung Lin, Jhi-Joung Wang, and How-Ran Guo. 2018. "Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning" Journal of Clinical Medicine 7, no. 10: 349. https://doi.org/10.3390/jcm7100349