Assessment of Usefulness of S100B Protein as a Predictor Factor of Delayed Encephalopathy in Acute Carbon Monoxide Poisoning: Prospective Study in the Poison Control Center, Ain Shams University (PCCA)

Abstract

Carbon monoxide poisoning is considered to be one of the leading causes of death worldwide and neurological sequelae are the most frequent form of morbidity. Clinical features of the delayed neurological sequelae included cognitive impairments (impairment in verbal or visual episodic memory, language, executive function and calculation), affective disorders and abnormal neurological signs that developed between 2-40 days after acute carbon monoxide (CO) poisoning. Prevention of delayed neurological sequelae after acute carbon monoxide became the main goal of treatment. Predicting development of DNS during the acute phase of acute carbon monoxide would help in making treatment decision by such means as identifying cases to which HBO therapy should be actively administered and setting an appropriate period of hospital treatment and also considering appropriate follow up period. This study aimed to assess usefulness of S100B protein for predicting delayed neurological sequelae (DNS) in acute carbon monoxide toxicity. Also, this study aimed to assess the correlation of S100B protein to clinical picture, other neurobiochemical markers and CT finding and hence can improve outcome and decrease occurrence of delayed complications after acute carbon monoxide poisoning. This case control study was conducted on 40 patients of both sexes who were admitted to the Poison Control Center (PCCA), Ain Shams University Hospitals, with admission diagnosis of acute CO intoxication, in the period starting from 1st of December 2013 to 30th of June 2015. The diagnosis of acute CO intoxication was established according to potential CO exposure history, clinical findings (such as alteration in mentation, syncope, seizures, shortness of breath, chest pain and palpitation) and, or COHb > 5% in nonsmokers or greater than 15% in smokers. Twenty healthy volunteers served as control group. Patients with history of carbon monoxide poisoning due to fire, previous history of neuropsychiatric disease, a post-cardiac arrest state, current head trauma, or melanoma were excluded from the study. The enrolled subjects in this study were divided into three groups: Group 1: Patients with delayed neuropsychiatric syndrome (DNS). Group 2: Patients without delayed neuropsychiatric syndrome (DNS). Group 3: 20 healthy volunteers served as control group. Written informed consent was obtained from patients' guardians. All groups were subjected to the following: Full medical history: including (source of CO, CO exposure duration, delay time before arrival to ER, Comorbidity, symptoms of CO poisoning and pre presentation treatment).