The inflammatory markers MHR and NLR are independent risk factors for adverse events during hospitalization in older adult patients with myocardial injury caused by acute carbon monoxide poisoning: a retrospective cross-sectional study

Zhang, Jing1; Yang, Jing1; Wu, Liyang2,*

Author Information

1Department of Hyperbaric Oxygen, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

2Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

*Correspondence to: Liyang Wu, MD, PhD, urowly@live.com.

Abstract

Acute carbon monoxide poisoning-induced myocardial injury is easily overlooked. However, patients with acute carbon monoxide poisoning, especially older adult patients, often have difficulty expressing clinical symptoms due to early consciousness disturbances, making the early identification of complications challenging and leading to delayed diagnosis and treatment. Therefore, exploring indicators that can predict in-hospital cardiovascular adverse events in older adult patients with acute carbon monoxide poisoning -induced myocardial injury has important clinical significance. Therefore, this retrospective cross-sectional study included older adult patients with acute carbon monoxide poisoning-induced myocardial injury at the Department of Hyperbaric Oxygen of Beijing Chao-Yang Hospital from January 2013 to December 2019. A total of 119 older adult patients with acute carbon monoxide poisoning-induced myocardial injury were included in the study, with 94 patients in the nonevent group (54 males, 40 females, 71.09 ± 7.60 years) and 25 patients in the cardiovascular adverse event group (10 males, 15 females, 71.48 ± 10.38 years). Compared with those in the nonevent group, creatine kinase isoenzyme levels, triglyceride levels, the neutrophil/lymphocyte ratio and the monocyte/high-density lipoprotein cholesterol ratio were significantly greater in the cardiovascular adverse event group, and high-density lipoprotein cholesterol levels were significantly lower in the cardiovascular adverse event group. Further binary logistic regression analysis showed that higher monocyte/high-density lipoprotein cholesterol ratio might be an independent risk factor for in-hospital adverse events in older adult patients with acute carbon monoxide poisoning-induced myocardial injury (OR = 109.783, 95% CI: 2.644–4557.834; P = 0.013). The area under the curve of the monocyte/high-density lipoprotein cholesterol ratio in predicting in-hospital cardiovascular adverse events in older adult patients with myocardial injury due to acute carbon monoxide poisoning was 0.797, the cutoff value was 0.645, the sensitivity was 68.0%, and the specificity was 88.2%. The inflammatory indicators monocyte/high-density lipoprotein cholesterol ratio and neutrophil/lymphocyte ratio were identified as an independent risk factor for predicting in-hospital cardiovascular adverse events in older adult patients with acute carbon monoxide poisoning-induced myocardial injury in this study. Specifically, monocyte/high-density lipoprotein cholesterol ratio was identified as an independent risk factor for predicting adverse events during hospitalization.

摘要

急性一氧化碳中毒诱导的心肌损伤易被忽视。然而，急性一氧化碳中毒患者，尤其是老年患者，常因早期意识障碍而难以表述临床症状，这使得并发症的早期识别面临挑战，并导致诊断和治疗的延误。因此，探索能够预测老年急性一氧化碳中毒心肌损伤患者发生院内不良心血管事件的指标具有重要的临床意义。为此，这项回顾性横断面研究纳入了2013年1月至2019年12月期间在北京朝阳医院高压氧科就诊的老年急性一氧化碳中毒心肌损伤患者。研究共纳入119例老年急性一氧化碳中毒心肌损伤患者，其中无事件组94例（男54例，女40例，年龄71.09±7.60岁），心血管不良事件组25例（男10例，女15例，年龄71.48±10.38岁）。与无事件组相比，心血管不良事件组的肌酸激酶同工酶水平、甘油三酯水平、中性粒细胞/淋巴细胞比值和单核细胞/高密度脂蛋白胆固醇比值显著更高，而高密度脂蛋白胆固醇水平显著更低。进一步的二元Logistic回归分析显示，较高的单核细胞/高密度脂蛋白胆固醇比值可能是老年急性一氧化碳中毒心肌损伤患者发生院内不良事件的独立危险因素（OR = 109.783，95% CI: 2.644–4557.834；P = 0.013）。单核细胞/高密度脂蛋白胆固醇比值预测老年急性一氧化碳中毒心肌损伤患者发生院内心血管不良事件的曲线下面积为0.797，截断值为0.645，敏感性为68.0%，特异性为88.2%。本研究中，炎症指标单核细胞/高密度脂蛋白胆固醇比值和中性粒细胞/淋巴细胞比值被确定为预测老年急性一氧化碳中毒心肌损伤患者发生院内心血管不良事件的独立危险因素。具体而言，单核细胞/高密度脂蛋白胆固醇比值被确定为预测住院期间不良事件的独立危险因素。