Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 20, 2023; 13(4): 248-258
Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.248
Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity
Abuzer Coskun, Burak Demirci, Kenan Ahmet Turkdogan
Abuzer Coskun, Burak Demirci, Emergency Medicine Clinic, Istanbul Bagcilar Training and Research Hospital, Istanbul 34200, Turkey
Kenan Ahmet Turkdogan, Emergency Medicine Department, Istanbul Çam and Sakura City Hospital, Istanbul 34494, Turkey
Author contributions: Coskun A and Demirci B contributed to study design, concept, writing the manuscript, and revising the final form; Coskun A and Turkdogan KA contributed to data collection and manuscript revision; All authors contributed to writing and discussion management; All authors contributed to data management and manuscript revision, data collection, interpretation of data, and revising the manuscript; Coskun A contributed to data collection and revision; Turkdogan KA contributed to data collection; Demirci B contributed to critical revision; Turkdogan KA contributed to statistical analysis; Coskun A suggested the idea, as a chair of the department provided general support and substantial contribution to concept and design, and acquisition of data; All authors read and approved the final manuscript.
Institutional review board statement: All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the last Declaration of Helsinki (2013), and the protocol was approved by the Ethics Committee of Project identification (Decision No: 136).
Conflict-of-interest statement: The authors report there are no competing interests to declare.
Data sharing statement: Informed Consent Form belonging to the research titled "Clinical Relation of Carboxyhemoglobin Levels in Carbon Monoxide Poisonings with COVID-19", which I conducted, was uploaded to the approved system on April 22, 2022.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abuzer Coskun, MD, Associate Professor, Emergency Medicine Clinic, Istanbul Bagcilar Training and Research Hospital, No. 2, Dr. Sadik Ahmet Street, Istanbul 34200, Turkey. dr.acoskun44@hotmail.com
Received: April 10, 2023
Peer-review started: April 10, 2023
First decision: June 1, 2023
Revised: June 8, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: September 20, 2023
Processing time: 163 Days and 4.4 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19), which recently spread throughout the entire world, is still a significant health issue. Additionally, the most common cause of risky poisoning in emergency services is carbon monoxide (CO) poisoning. Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs.

AIM

To determine how arterial blood gas and carboxyhemoglobin (COHb) levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning.

METHODS

Between January 2018 and December 2021, 479 CO-poisoning patients participated in this single-center, retrospective study. Patients were primarily divided into two groups for analysis: Pre-pandemic and pandemic periods. Additionally, the pandemic era was divided into categories based on the presence of COVID-19 and, if present, the clinical severity of the infection. The hospital information system was used to extract patient demographic, clinical, arterial blood gas, COVID-19 polymerase chain reaction, and other laboratory data.

RESULTS

The mean age of the 479 patients was 54.93 ± 11.51 years, and 187 (39%) were female. 226 (47%) patients were in the pandemic group and 143 (30%) of them had a history of COVID-19. While the mean potential of hydrogen (pH) in arterial blood gas of all patients was 7.28 ± 0.15, it was 7.35 ± 0.10 in the pre-pandemic group and 7.05 ± 0.16 in the severe group during the pandemic period (P < 0.001). COHb was 23.98 ± 4.19% in the outpatients and 45.26% ± 3.19% in the mortality group (P < 0.001). Partial arterial oxygen pressure (PaO2) was 89.63 ± 7.62 mmHg in the pre-pandemic group, and 79.50 ± 7.18 mmHg in the severe group during the pandemic period (P < 0.001). Despite the fact that mortality occurred in 35 (7%) of all cases, pandemic cases accounted for 30 of these deaths (85.7%) (P <0.001). The association between COHb, troponin, lactate, partial arterial pressure of carbon dioxide, HCO3, calcium, glucose, age, pH, PaO2, potassium, sodium, and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis.

CONCLUSION

Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences. In patients with a history of pandemic COVID-19, clinical results and survival are considerably unfavorable in cases of CO poisoning.

Keywords: Emergency department; Coronavirus disease 2019; Carbon monoxide; Mortality; Carboxyhemoglobin; Intoxication; Poisoning

Core Tip: This retrospective study included 479 patients with a mean age of 54 years. The association of both coronavirus disease 2019 and carbon monoxide poisoning in the emergency department has not been described in the literature. This study includes meticulous work on this association carried out in the emergency room. The clinical, hospitalization, complication and mortality rates were evaluated.