Diagnostic Value of Parameters Related to White Blood Cell Counts for Troponin I Elevation in CO Poisoning
- 13 Downloads
To assess myocardial injury related to acute carbon monoxide (CO) poisoning, serial troponin I is measured in patients not presenting with troponin I elevation. This retrospective study investigated whether parameters related to white blood cell (WBC) counts (total and differential WBC counts, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio) improved predictive accuracy for troponin I elevation (> 0.04 ng/ml) in patients not presenting with evidence of myocardial injury. Serial parameters, troponin I values, and clinical courses were collected in 241 patients. Troponin I was elevated in 33 (13.7%) patients after hospitalization. The median lag times to troponin I elevation in patients with undetectable and detectable troponin I (0.015 ng/ml ≤ troponin I ≤ 0.04 ng/ml) at presentation were 5.9 h and 3.0 h, respectively. Patients with troponin I elevation after presentation had higher total WBC and neutrophil counts and NLRs and a lower lymphocyte count during the first 4 h after presentation than patients without troponin I elevation during hospitalization. Total WBC count, neutrophil count, and log NLR at presentation were selected as independent predictive factors for troponin I elevation after presentation. However, only the neutrophil count and log NLR at presentation improved the predictive accuracy in combination with clinical parameters compared with that achieved with a predictive model including only clinical parameters. The optimal cut-off neutrophil count and NLR were 5.21 × 103 /uL and 4.02, respectively. The total neutrophil count and NLR, which are widely available and inexpensive parameters obtained in the emergency department (ED), are promising screening tools for predicting the risk of troponin I elevation in patients without evidence of myocardial injury-related acute CO poisoning at presentation.
KeywordsCarbon monoxide Lymphocyte Neutrophil Poisoning Troponin I
Compliance with Ethical Standards
Conflict of interest
The authors declare that we have no conflict of interest.
- 4.Kao, H. K., Lien, T. C., Kou, Y. R., & Wang, J. H. (2009). Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulmonary Pharmacology and Therapeutics, 22, 473–477.CrossRefGoogle Scholar
- 10.Sabatine, M. S., Morrow, D. A., Cannon, C. P., Murphy, S. A., Demopoulos, L. A., DiBattiste, P. M., McCabe, C. H., Braunwald, E., & Gibson, C. M. (2002). Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (treat angina with aggrastat and determine cost of therapy with an invasive or conservative strategy- thrombolysis in myocardial infarction 18 trial) substudy. Journal of the American College of Cardiology, 40(10), 1761–1768.CrossRefGoogle Scholar
- 16.Schnittger, V., Rosendahl, K., Lind, F., & Palmblad, J. (2004). Effects of carbon monoxide poisoning on neutrophil responses in patients treated with hyperbaric oxygen. Journal of Investigative Medicine, 52, 523–530.Google Scholar
- 19.Han, Y. Y., Wang, Y., Zhao, G. Q., Yang, J. L., Wang, L., & Wang, W. Z. (2018). Relationship between neutrophil-to-lymphocyte ratio and myocardial injury induced by acute carbon monoxide poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi, 36, 362–364.Google Scholar
- 21.Ishikawa, T., Quan, L., Michiue, T., Kawamoto, O., Wang, Q., Chen, J. H., Zhu, B. L., & Maeda, H. (2013). Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Science International, 228, 52–60.CrossRefGoogle Scholar
- 23.Boag, S. E., Das, R., Shmeleva, E. V., Bagnall, A., Egred, M., Howard, N., Bennaceur, K., Zaman, A., Keavney, B., & Spyridopoulos, I. (2015). T lymphocytes and fractalkine contribute to myocardial ischemia/reperfusion injury in patients. The Journal of Clinical Investigation, 125, 3063–3076.CrossRefGoogle Scholar
- 29.Yelken, B., Tanriverdi, B., Cetinbaş, F., Memiş, D., & Süt, N. (2009). The assessment of QT intervals in acute carbon monoxide poisoning. Anadolu Kardiyoloji Dergisi, 9, 397–400.Google Scholar
- 32.Bossard, M., Thériault, S., Aeschbacher, S., Schoen, T., Kunz, S., von Rotz, M., Estis, J., Todd, J., Risch, M., Mueller, C., Risch, L., Paré, G., & Conen, D. (2017). Factors independently associated with cardiac troponin I levels in young and healthy adults from the general population. Clinical Research in Cardiology, 106, 96–104.CrossRefGoogle Scholar