Authors
Baoyue Zhu, Qianqian Zhu, Yueru Du, Qingmian Xiao, Weizhan Wang, Hongna Qi
Published in
Zhonghua wei zhong bing ji jiu yi xue. Volume 38. Issue 5. Pages 544-551.
Abstract
To explore the correlation between blood urea nitrogen/albumin (B/A) ratio, central nervous system specific protein S100 (S100β), cardiac troponin I (cTnI) and the severity assessment and prognosis in patients with moderate-to-severe acute carbon monoxide poisoning (ACMP).
A retrospective cohort study was performed, enrolling patients with moderate-to-severe ACMP admitted to the Harrison International Peace Hospital from March 1, 2023 to December 31, 2025 as the study subjects. Baseline clinical data at admission were recorded, including coma duration, time from poisoning to presentation, etc. Blood routine examination, electrolyte levels, liver function, blood glucose, C-reactive protein (CRP), blood lactic acid (Lac), blood urea nitrogen (BUN), albumin (Alb), cTnI, S100β, as well as BUN, Alb, cTnI, S100β at admission and 3 days after admission were collected, and the B/A ratio was calculated. Patients were followed up for 60 days to assess clinical prognosis. According to the severity of the patients' condition, they were stratified into the moderate poisoning group and the severe poisoning group; further, based on the occurrence of delayed carbon monoxide encephalopathy (DEACMP) during the 60-day follow-up, they were divided into the good prognosis group and the poor prognosis group. Pearson correlation analysis was used to explore the associations of B/A ratio, S100β, and cTnI with the severity of ACMP patients and the occurrence of DEACMP; stepwise logistic regression analysis was used to analyze the influencing factors of DEACMP occurrence in ACMP patients; receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of B/A ratio, S100β, cTnI, and their combined detection for DEACMP occurrence in ACMP patients.
A total of 178 patients with moderate-to-severe ACMP were enrolled, including 91 in the moderate poisoning group and 87 in the severe poisoning group; 157 in the good prognosis group and 21 in the poor prognosis group. In terms of disease severity, compared with the moderate poisoning group, the severe poisoning group had faster pulse and respiratory rates upon admission, longer coma duration and time from poisoning to treatment, higher levels of blood glucose, CRP, Lac, and BUN, and lower Alb levels (all P<0.05). In addition, the B/A ratio, S100β, and cTnI levels in the severe poisoning group were all higher than those in the moderate poisoning group at admission and 3 days after admission (all P<0.05). Compared with admission, the B/A ratio increased and the cTnI level decreased in the moderate poisoning group at 3 days after admission (both P<0.05), while S100β showed no significant change. In the severe poisoning group, there was no statistically significant difference in the B/A ratio, S100β, and cTnI levels at 3 days after admission compared to those at admission. In terms of prognosis, compared with the good prognosis group, the poor prognosis group had longer coma duration and time from poisoning to treatment at admission, a higher proportion of severe poisoning patients, higher levels of blood glucose, CRP, Lac, and BUN, and lower Alb levels (all P<0.05). In addition, the B/A ratio, S100β, and cTnI levels at admission and 3 days after admission were higher in the poor prognosis group than in the good prognosis group (all P<0.05). Correlation analysis showed that the B/A ratio, S100β, and cTnI levels at admission and 3 days after admission were correlated with the severity of ACMP and the occurrence of DEACMP (both P<0.05). Stepwise logistic regression analysis showed that the elevated B/A ratio [at admission: odds ratio (OR)=1.272, 95% confidence interval (95%CI)=1.028-1.573; on admission day 3: OR=1.170, 95%CI was 0.947-1.463], S100β (on admission: OR=1.065, 95%CI was 1.007-1.127; on admission day 3: OR=1.112, 95%CI was 1.060-1.165), and cTnI (on admission: OR=1.358, 95%CI was 1.055-1.748; on admission day 3: OR=1.201, 95%CI was 1.008-1.432) at admission and 3 days after admission were all risk factors for DEACMP in patients with ACMP (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) for the combined prediction of DEACMP occurrence using B/A ratio, S100β, and cTnI on admission and on admission day 3 were 0.872 and 0.904, respectively. The sensitivities were 95.2% and 85.7%, respectively, and the specificities were 68.8% and 80.3%, respectively. The combined prediction efficacy of the three markers on admission was superior to that of the degree of intoxication and individual detection of the three markers, and the combined prediction efficacy of the three markers on admission day 3 was superior to that of the degree of intoxication, coma duration, and individual prediction of the three markers. Furthermore, the combined detection of the three markers on admission day 3 had a superior predictive efficacy compared to that on admission (all P<0.05).
Patients with moderate to severe ACMP are at higher risk of developing DEACMP when their early circulating levels of the B/A ratio, S100β, and cTnI are elevated. Combined detection of these three biomarkers facilitates early screening for DEACMP, with the highest predictive value observed at 3 days after admission.
PMID:
42427327
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.
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