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Usefulness of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as a marker for cardiotoxicity and comparison with echocardiography in paediatric carbon monoxide poisoning

Published online by Cambridge University Press:  23 June 2020

Caner Turan Open the ORCID record for Caner Turan [Opens in a new window] ,
Eser Dogan ,
Ali Yurtseven Open the ORCID record for Ali Yurtseven [Opens in a new window]  and
Eylem Ulas Saz
Caner Turan
Affiliation:
Department of Pediatrics, Division of Pediatric Emergency, Ege University School of Medicine, Izmir, Turkey
Eser Dogan
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Ege University School of Medicine, Izmir, Turkey
Ali Yurtseven*
Affiliation:
Department of Pediatrics, Division of Pediatric Emergency, Ege University School of Medicine, Izmir, Turkey
Eylem Ulas Saz
Affiliation:
Department of Pediatrics, Division of Pediatric Emergency, Ege University School of Medicine, Izmir, Turkey
*
Author for correspondence: Ali Yurtseven, Department of Pediatrics, Division of Pediatric Emergency, Ege University Children Hospital, Kazimdirik Street, Bornova, Izmir, Turkey. Tel: +905052052144; Fax: +902323901357. E-mail: aliyurtseven1605@gmail.com
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Abstract

Objectives:

To demonstrate the usefulness of N-Terminal Pro-B-Type natriuretic peptide (NT-proBNP) as an early biomarker of carbon monoxide-induced myocardial injury in children. It also aimed to identify the correlation between NT-proBNP and left ventricular systolic dysfunction findings shown by echocardiography.

Methods:

Prospective, observational study conducted at a paediatric emergency department between October 2017 and April 2019 which involved children aged 0–17 years. The patients were divided into three groups based on severity; mild, moderate and severe groups. The patient characteristics, carboxyhaemoglobin, CK-MB Mass (CKMB-M), troponin-T, and NT-proBNP levels were measured, and echocardiography was performed and left ventricular ejection fraction was measured.

Results:

Sixty-nine patients and 60 healthy controls were included. Male gender, younger age, higher carboxyhaemoglobin levels, and altered mental status were found as independent predictors of carbon monoxide-induced myocardial injury. If the cut-off value for NT-proBNP level is >480 pg/ml, the sensitivity–specificity for decreased left ventricular ejection fraction, which is the strongest carbon monoxide-induced myocardial injury sign, were 100–96%, respectively. A high negative correlation was found between NT-proBNP levels and left ventricular ejection fraction (r = −0.769, p < 0.01) in the carbon monoxide poisoning group, and there was a positive correlation between the carboxyhaemoglobin and NT-proBNP levels (r = 0.583, p < 0.01).

Conclusion:

Echocardiography is an ideal tool and very sensitive, but its routine use is limited due to its non-availability. An increased level of NT-proBNP (>480pg/ml) may be useful as an ideal biomarker for early detection of carbon monoxide-induced myocardial injury sign and reduced left ventricular ejection fraction which is the most crucial point in making a decision on hyperbaric oxygen therapy.

Keywords

Carbon monoxideNT-ProBNPechocardiographymyocardial injurychildren
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 8 , August 2020 , pp. 1103 - 1108
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Can, G, Sayılı, U, Aksu Sayman, Ö, et al.Mapping of carbon monoxide related deathrisk in Turkey: a ten-year analysis based on news agency records. BMC Public Health 2019; 19: 9. doi: 10.1186/s12889-018-6342-4CrossRefGoogle ScholarPubMed
Ihlas Haber Ajansi. https://www.haberturk.com/bursa-haberleri/65410132-sessiz-olume-dikkatturkiyede-2018-yilinda-116-kisi-karbonmonoksit-zehirlenmesinden-hayatini. Accessed on November 07, 2019.Google Scholar
Gorman, D, Drewry, A, Huang, YL, Sames, C.The clinical toxicology of carbon monoxide. Toxicology 2003; 187: 25–38. doi: 10.1016/s0300-483x(03)00005-2CrossRefGoogle ScholarPubMed
Ozyurt, A, Karpuz, D, Yucel, A, Tosun, MD, Kibar, AE, Hallioglu, O.Effects of acute carbon monoxide poisoning on ECG and echocardiographic parameters in children. Cardiovasc Toxicol 2017; 17: 326–334. doi: 10.1007/s12012-016-9389-4CrossRefGoogle ScholarPubMed
Ernst, A, Zibrak, JD.Carbon monoxide poisoning. N Engl J Med 1998; 339: 1603–1608.CrossRefGoogle ScholarPubMed
Dragelyte, G, Plenta, J, Chmieliauskas, S, et al.Myocardial rupture following carbon monoxide poisoning. Case Rep Crit Care 2014; 2014: 281701. doi: 10.1155/2014/281701Google ScholarPubMed
Davutoglu, V, Gunay, N, Kocoglu, H, et al.Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning. Inhal Toxicol 2006; 18: 155–158. doi: 10.1080/08958370500305885CrossRefGoogle ScholarPubMed
Thomassen, Ø, Brattebø, G, Rostrup, M.Carbon monoxide poisoning while using a small cooking stove in a tent. Am J Emerg Med 2004; 22: 204–206. doi: 10.1016/j.ajem.2004.02.011CrossRefGoogle Scholar
Al-Hadi, HA, Fox, KA.Cardiac markers in the early diagnosis and management of patients with acute coronary syndrome. Sultan Qaboos Univ Med J 2009; 9: 231–246.Google ScholarPubMed
Aydin, S, Ugur, K, Aydin, S, Sahin, I, Yardim, M.Biomarkers in acute myocardial infarction: current perspectives. Vasc Health Risk Manag 2019; 15: 1–10.doi: 10.2147/VHRM.S166157CrossRefGoogle ScholarPubMed
Kao, LW, Nañagas, KA.Carbon monoxide poisoning. Emerg Med Clin North Am 2004; 22: 985. doi: 10.1016/j.emc.2004.05.003CrossRefGoogle ScholarPubMed
Huang, CC, Ho, CH, Chen, YC, et al.Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning. Chest 2017; 152: 943. doi: 10.1016/j.chest.2017.03.049CrossRefGoogle Scholar
Bhutani, S, Vishwanath, G.Hyperbaric oxygen and wound healing. Indian J Plast Surg. 2012; 45: 316–324. doi: 10.4103/0970-0358.101309Google ScholarPubMed
Stienen, S, Salah, K, Moons, AH, et al.NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-guided therapy in acute decompensated heart failure: PRIMA II randomized controlled trial (Can NT-ProBNP-guided therapy during hospital admission for acute decompensated heart failure reduce mortality and readmissions?). Circulation 2018; 137: 1671–1683. doi: 10.1161/CIRCULATIONAHA.117.029882CrossRefGoogle Scholar
Zheng, YR, Ye, LF, Cen, XJ, Lin, JY, Fu, JW, Wang, LH.Low NT-proBNP levels: an early sign for the diagnosis of ischemic heart failure. Int J Cardiol 2017; 228: 666–671. doi: 10.1016/j.ijcard.2016.11.139CrossRefGoogle Scholar
Satran, D, Henry, CR, Adkinson, C, Nicholson, CI, Bracha, Y, Henry, TD.Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol 2005; 45: 1513–1516. doi: 10.1016/j.jacc.2005.01.044CrossRefGoogle ScholarPubMed
Cha, YS, Cha, KC, Kim, OH, Lee, KH, Hwang, SO, Kim, H.Features and predictors of myocardial injury in carbon monoxide poisoned patients. Emerg Med J 2014; 31: 210–215. doi: 10.1136/emermed-2012-202152CrossRefGoogle ScholarPubMed
Tibbles, PM, Edelsberg, JS.Hyperbaric-oxygen therapy. N Engl J Med 1996; 334: 1642–1648.CrossRefGoogle ScholarPubMed
Thom, SR, Fisher, D, Xu, YA, et al.Adaptive responses and apoptosisnin endothelial cells exposed to carbon monoxide. Proc Nat Acad Sci USA 2000; 97: 1305–1310.CrossRefGoogle ScholarPubMed
Teksam, O, Gumus, P, Bayrakci, B, Erdogan, I, Kale, G.Acute cardiac effects of carbon monoxide poisoning in children. Eur J Emerg Med 2010; 17: 192–196. doi: 10.1097/MEJ.0b013e328320ad48CrossRefGoogle ScholarPubMed
Sonmez, FT, Gunes, H, Saritas, A, Kandis, H.Carbon monoxide poisoning: clinical manifestations, consequences, monitoring, diagnosis and treatment of toxicity. Konuralp Medical J. 2015; 7: 192–198.Google Scholar
Aslan, S, Uzkeser, M, Seven, B, et al.The evaluation of myocardial damage in 83young adults with carbon monoxide poisoning in the East Anatolia region in Turkey. Hum Exp Toxicol 2006; 25: 439–446. doi: 10.1191/0960327106het645oaCrossRefGoogle ScholarPubMed
Henry, CR, Satran, D, Lindgren, B, Adkinson, C, Nicholson, CI, Henry, TD.Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006; 295: 398–402. doi: 10.1001/jama.295.4.398CrossRefGoogle ScholarPubMed
Eichhorn, L, Thudium, M, Jüttner, B.The diagnosis and treatment of carbon monoxide poisoning. Dtsch Arztebl Int 2018; 115: 863–870. doi: 10.3238/arztebl.2018.0863Google ScholarPubMed
Huysal, K, Ustundag Budak, Y, Aydin, U, Demirci, H, Turk, T, Karadag, M.COHb level and high-sensitivity cardiac troponin T in 2012 in Bursa, Turkey: a retrospective single-center study. Iran Red Crescent Med J 2016; 18: e27061. doi: 10.5812/ircmj.27061CrossRefGoogle ScholarPubMed
Cardiga, R, Proença, M, Carvalho, C, et al.What do we know about carbon monoxide poisoning and cardiac compromise? Revista Portuguesa de Cardiologia 2015; 34: 557. doi: 10.1016/j.repc.2015.01.006Google ScholarPubMed
Smiseth, OA, Torp, H, Opdahl, A, Haugaa, KH, Urheim, S.Myocardial strain imaging: How useful is it in clinical decision making? Eur Heart J 2016; 37: 1196–1207. doi: 10.1093/eurheartj/ehv529CrossRefGoogle ScholarPubMed
Secilmis, Y, Ozturk, MA.Factors that affect prognosis and morbidity in pediatric patients with carbon monoxide poisoning. J Pediatr Emerg Intensive Care Med 2018; 5: 113–118. doi: 10.4274/cayd.71463CrossRefGoogle Scholar
Saraçoğlu, E, Vuruşkan, E, Kılıç, S, et al.Predicting cardiotoxic effects of carbon monoxide poisoning using speckle tracking echocardiography. Cardiovasc Toxicol 2018; 18: 175–183. doi: 10.1007/s12012-017-9428-9CrossRefGoogle ScholarPubMed
Lee, JH, Kim, HS, Park, JH, et al.Incidence and clinical course of left ventricular systolic dysfunction in patients with carbon monoxide poisoning. Korean Circ J 2016; 46: 665–671. doi: 10.4070/kcj.2016.46.5.665CrossRefGoogle ScholarPubMed
Liu, SD, Shen, Q, Lv, C, et al.Analysis of combined detection of N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction in heart function in patients with acute CO poisoning. Am J Emerg Med 2014;32:1212–1214. doi: 10.1016/j.ajem.2014.07.012CrossRefGoogle ScholarPubMed
Mir, TS, Flato, M, Falkenberg, J, et al.Plasma concentrations of N-terminal brain natriuretic peptide in healthy children, adolescents, and young adults: effect of age and gender. Pediatr Cardiol 2006; 27: 73–77.CrossRefGoogle Scholar
Yucel, M, Avsarogullari, L, Durukan, P, et al.BNP shows myocardial injury earlier than Troponin-I in experimental carbon monoxide poisoning. Eur Rev Med Pharmacol Sci 2016;20:1149–1154.Google ScholarPubMed
Moon, JM, Chun, BJ, Shin, MH, Lee, SD.Serum N-terminal proBNP, not troponin I, at presentation predicts long-term neurologic outcome in acute charcoal-burning carbon monoxide intoxication. Clin Toxicol (Phila) 2018; 56: 412–420.CrossRefGoogle Scholar