A clinical nomogram incorporating hyperhomocysteinemia for predicting severe delayed encephalopathy after acute carbon monoxide poisoning: a retrospective single-center study.

Authors

Wanqiu Zhu, Yi Zhang, Fang Liang, Shuhua Yuan, Yu Gao, Xuehua Liu, Xiaomin Hou, Linlin Ma, Jing Zhang, Ding Nan, Lu Yang, Yafei He, Jing Yang

Published in

Frontiers in medicine. Volume 13. Pages 1857056. Epub Jun 24, 2026.

Abstract

Severe delayed encephalopathy after acute carbon monoxide poisoning (s-DEACMP) is a disabling complication associated with substantial long-term neurological impairment, yet reliable predictors for risk stratification during acute hospitalization remain limited. This study aimed to identify predictors associated with s-DEACMP and to develop a preliminary predictive model.
In this retrospective single-center cohort study, 200 patients with acute carbon monoxide poisoning (ACMP) admitted between 2017 and 2024 were analyzed. Patients were categorized into DEACMP (n = 140) and non-DEACMP (n = 60) groups; the DEACMP group was further stratified into severe (s-DEACMP, n = 97) and mild-to-moderate (m-DEACMP, n = 43) subgroups based on Activities of Daily Living scores assessed at peak disease severity during hospitalization. Clinical characteristics were compared between the s-DEACMP group and a combined control group (n-DEACMP + m-DEACMP). Independent predictors were identified using multivariate logistic regression. A nomogram was constructed and internally validated using receiver operating characteristic (ROC) curves, calibration analysis, and decision curve analysis (DCA).
Patients with s-DEACMP were significantly older and had longer duration of disturbance of consciousness, higher prevalence of hypertension and hyperhomocysteinemia, elevated D-dimer levels, and lower serum albumin concentrations compared with controls (all P < 0.05). Multivariate analysis identified age >40 years (OR = 31.90, 95% CI = 3.93-259.14), disturbance of consciousness >24 h (OR = 3.06, 95% CI = 1.58-5.94), hypertension (OR = 1.99, 95% CI = 1.02-3.90), and hyperhomocysteinemia (OR = 2.57, 95% CI = 1.24-5.31) as factors independently associated with s-DEACMP. The nomogram demonstrated acceptable discrimination and calibration.
The proposed nomogram may assist in identifying patients at increased risk for s-DEACMP during acute hospitalization. External multicenter validation is required before broader clinical application.

PMID:
42422846
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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