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J Korean Soc Emerg Med > Volume 29(5); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(5): 519-528.
일산화탄소중독에서 지연신경정신장애의 장기적인 예후
유주영, 김갑득, 고찬영
단국대학교 의과대학 응급의학교실
Long-term outcome of delayed neuropsychiatric sequelae after carbon monoxide poisoning
Joo Young Yoo, Gap Teog Kim, Chan Young Koh
Department of Emergency Medicine, Dankook University College of Medicine, Cheonan, Korea
Correspondence  Gap Teog Kim ,Tel: 041-550-7240, Fax: 041-550-7120, Email: gtkim@dankook.ac.kr,
Received: June 5, 2018; Revised: July 26, 2018   Accepted: August 28, 2018.  Published online: October 31, 2018.
Delayed neuropsychiatric sequelae (DNS) following carbon monoxide (CO) poisoning, which may result from a demyelinating leukoencephalopathy, is a disease with a poor prognosis. This study examined the factors affecting the long-term prognosis of DNS and the efficacy of hyperbaric oxygen therapy (HBOT) in patients with DNS.
This retrospective study included 84 patients with DNS following CO poisoning from January 2013 to June 2016. HBOT was given to 24 patients. The patients were divided into an improvement group and non-improvement group based on their clinical condition on a telephone interview at intervals between 3 months and 3 years after the onset of DNS. The improvement group was defined as having Cerebral Performance Category (CPC) scores in their daily life that improve to 1 or 2 grade.
Of the 594 patients, DNS were found in 18.2%, and 70.2% (59 of 84) of the patients with DNS improved. The prognostic factors for the improvement of DNS were an age of 45 years or less (odds ratio [OR], 12.068; 95% confidence interval [CI], 2.393-60.858; P<0.005), CPC score of 1 or 2 group at the time of DNS onset (OR, 12.361; 95% CI, 3.161-48.330; P<0.005), and a lucid interval longer than 20 days (OR, 5.164; 95% CI, 1.393-19.141; P<0.01). HBOT was not associated with the improvement of DNS in CO poisoning (OR, 0.467; 95% CI, 0.172-1.269; P>0.1).
Patients aged less than 45 years, low grade CPC score of 1 and 2, and lucid interval longer than 20 days are more likely to have a good prognosis. On the other hand, HBOT failed to produce a benefit for DNS patients.
Key words: Carbon monoxide; Delayed neuropsychiatric sequelae; Prognosis
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