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Incidence, timing, location, risk factors, and nomogram of lower extremity deep venous thrombosis after acute carbon monoxide poisoning

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Abstract

Introduction

Data on lower extremity deep venous thrombosis (DVT) following acute carbon monoxide (CO) poisoning are lacking. This study aimed to identify the incidence rate, timing, locations, risk factors, and nomogram of lower extremity DVT after acute CO poisoning.

Methods

A total of 203 patients with acute CO poisoning from October 2019 to April 2021 were included in this retrospective study. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with lower extremity DVT. Nomogram was drawn and area under the curve (AUC) was calculated to predict lower extremity DVT.

Results

Overall, 14.3% (29/203) had lower extremity DVT, with incidence rates of 2.5% (5/203) for proximal DVT and 11.8% (24/203) for distal DVT. The lower extremity DVTs involved intermuscular vein in 28 patients, popliteal vein in 5 patients, and posterior tibial vein in 3 patients. The mean time from end of exposure to diagnosis of lower extremity DVT was 1.24 days. Among 29 lower extremity DVT cases, 6 (23.1%) DVT cases had thrombolysis. Multivariate logistic regression analysis revealed that long coma duration (P < 0.001) and high D-dimer levels (P < 0.001) were significantly associated with lower extremity DVT. The discrimination of nomogram was good with AUC of 0.93 (95% CI, 0.89–0.98).

Conclusion

Clinicians should be aware of and concerned with lower extremity DVT after acute CO poisoning, especially in patients with long coma duration and high D-dimer levels.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

DVT:

Deep venous thrombosis

CO:

Carbon monoxide

AUC:

Area under the curve

References

  1. Chenoweth JA, Albertson TE, Greer MR (2021) Carbon monoxide poisoning. Crit Care Clin 37:657–672. https://doi.org/10.1016/j.ccc.2021.03.010

    Article  Google Scholar 

  2. Weaver LK (2020) Carbon monoxide poisoning. Undersea Hyperb Med 47:151–169. https://doi.org/10.22462/01.03.2020.17

  3. Townsend CL, Maynard RL (2002) Effects on health of prolonged exposure to low concentrations of carbon monoxide. Occup Environ Med 59:708–711. https://doi.org/10.1136/oem.59.10.708

    Article  CAS  Google Scholar 

  4. Parmentier-Decrucq E, Mathieu D (2019) Carbon monoxide poisoning. Rev Prat 69:75–79

    Google Scholar 

  5. Pourtaji A, Sahebkar A, Poorzand H et al (2021) Evaluation of the cardioprotective effect of granulocyte colony stimulating factor in patients with carbon monoxide poisoning. Protein Pept Lett 28:589–601. https://doi.org/10.2174/0929866527666201022112810

    Article  CAS  Google Scholar 

  6. Eguzkiza-Ezponda L, Algora-Martín AC, Rodríguez-Sánchez I et al (2020) Probable delayed neurological syndrome after carbon monoxide poisoning: a clinical case and a review of the literature. Rev Esp Geriatr Gerontol 55:175–177. https://doi.org/10.1016/j.regg.2019.09.002

    Article  Google Scholar 

  7. Ning K, Zhou YY, Zhang N et al (2020) Neurocognitive sequelae after carbon monoxide poisoning and hyperbaric oxygen therapy. Med Gas Res 10:30–36. https://doi.org/10.4103/2045-9912.279981

    Article  CAS  Google Scholar 

  8. Liao SC, Mao YC, Hung YM et al (2018) Predictive role of QTc prolongation in carbon monoxide poisoning-related delayed neuropsychiatric sequelae. Biomed Res Int 2018:2543018. https://doi.org/10.1155/2018/2543018

    Article  CAS  Google Scholar 

  9. Lettow I, Hoffmann A, Burmeister HP et al (2018) Delayed neuropsychological sequelae after carbon monoxide poisoning. Fortschr Neurol Psychiatr 86:342–347. https://doi.org/10.1055/a-0599-0737

    Article  Google Scholar 

  10. Garg J, Krishnamoorthy P, Palaniswamy C et al (2018) Cardiovascular abnormalities in carbon monoxide poisoning. Am J Ther 25:e339–e348. https://doi.org/10.1097/mjt.0000000000000016

    Article  Google Scholar 

  11. Huang CC, Chen TH, Ho CH et al (2021) Increased risk of congestive heart failure following carbon monoxide poisoning. Circ Heart Fail 14:e007267. https://doi.org/10.1161/circheartfailure.120.007267

    Article  Google Scholar 

  12. Gao Y, Gu H, Yang J et al (2021) Prognosis of patients in prolonged coma after severe carbon monoxide poisoning. Hum Exp Toxicol 40:1355–1361. https://doi.org/10.1177/0960327121997992

    Article  CAS  Google Scholar 

  13. Abdel Salam ME, Elawady EH, Khater AS et al (2021) Neuropsychiatric sequelae of acute carbon monoxide poisoning: the predictive role of neuron specific enolase and glial fibrillary acidic protein. Neurotoxicology 85:115–120. https://doi.org/10.1016/j.neuro.2021.05.003

    Article  CAS  Google Scholar 

  14. Del Moral-Barbudo B, Blancas R, Ballesteros-Ortega D et al (2020) Current and research therapies for the prevention and treatment of delayed neurological syndrome associated with carbon monoxide poisoning: a narrative review. Hum Exp Toxicol 39:765–772. https://doi.org/10.1177/0960327120901572

    Article  Google Scholar 

  15. Xu Y, Li W (2020) is carbon monoxide poisoning a risk factor or a bystander of deep venous thrombosis? Ann Emerg Med 75:781–782. https://doi.org/10.1016/j.annemergmed.2020.01.032

    Article  Google Scholar 

  16. Cho Y, Kang H, Oh J et al (2020) Risk of venous thromboembolism after carbon monoxide poisoning: a nationwide population-based study. Ann Emerg Med 75:587–596. https://doi.org/10.1016/j.annemergmed.2019.08.454

    Article  Google Scholar 

  17. Chung WS, Lin CL, Kao CH (2015) Carbon monoxide poisoning and risk of deep vein thrombosis and pulmonary embolism: a nationwide retrospective cohort study. J Epidemiol Community Health 69:557–562. https://doi.org/10.1136/jech-2014-205047

    Article  Google Scholar 

  18. Ma J, Du P, Qin J et al (2021) Incidence and risk factors predicting deep venous thrombosis of lower extremity following spinal fractures. Sci Rep 11:2441. https://doi.org/10.1038/s41598-021-82147-x

    Article  CAS  Google Scholar 

  19. Sato K, Date H, Michikawa T et al (2021) Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders. BMC Musculoskelet Disord 22:513. https://doi.org/10.1186/s12891-021-04405-3

    Article  CAS  Google Scholar 

  20. Han Q, Guo XT, Zhang HH et al (2017) Clinical effect of high pressure oxygen and Butylphthalide in the recovery of cerebral metabolism after carbon monoxide poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 35:591–593. https://doi.org/10.3760/cma.j.issn.1001-9391.2017.08.009

    Article  CAS  Google Scholar 

  21. Ozturk B, Arihan O, Coskun F et al (2016) Acute carbon monoxide poisoning alters hemorheological parameters in human. Clin Hemorheol Microcirc 61:591–597. https://doi.org/10.3233/ch-141919

    Article  Google Scholar 

  22. Ruth-Sahd LA, Zulkosky K, Fetter ME (2011) Carbon monoxide poisoning: case studies and review. Dimens Crit Care Nurs 30:303–314. https://doi.org/10.1097/DCC.0b013e31822fb017

    Article  Google Scholar 

  23. Felner JM, Churchwell AL, Murphy DA (1984) Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol 4:1041–1051. https://doi.org/10.1016/s0735-1097(84)80069-8

    Article  CAS  Google Scholar 

  24. Chen DG, Ju WH, Sun G et al (2010) Two cases of patients with a special performance of carbon monoxide poisoning and review the related literatures. Med Recapitulate 16:3352–3353. https://doi.org/10.3969/j.issn.1006-2084.2010.21.053

    Article  Google Scholar 

  25. Bockenstedt P (2003) D-dimer in venous thromboembolism. N Engl J Med 349:1203–1204. https://doi.org/10.1056/NEJMp030084

    Article  Google Scholar 

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Authors and Affiliations

  1. Emergency Department, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China

    Shun Yi Feng & Yong Li

Authors
  1. Shun Yi Feng
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  2. Yong Li
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Contributions

SYF and YL contribute to study design and literature search. SYF contribute to data collection, interpretation, and analysis. SYF contribute to manuscript writing and YL contribute to manuscript revisions.

Corresponding author

Correspondence to Yong Li.

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Ethics approval and consent to participate

This retrospective study has been approved by the Ethics Committee of Cangzhou Central Hospital (No 2020–016-02). Informed consent was waived because demographic, clinical, and biologic data were collected from medical records.

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Not applicable.

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The authors declare no competing interests.

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Feng, S., Li, Y. Incidence, timing, location, risk factors, and nomogram of lower extremity deep venous thrombosis after acute carbon monoxide poisoning. Ir J Med Sci 192, 417–422 (2023). https://doi.org/10.1007/s11845-022-02992-1

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  • DOI: https://doi.org/10.1007/s11845-022-02992-1

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