{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:40:57Z","timestamp":1792096857366,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T00:00:00Z","timestamp":1692921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Carbon monoxide (CO) poisoning accounts for over 50,000 estimated emergency room visits and approximately 1200 deaths per year in the US. Despite the high prevalence, there is a paucity of data looking at the association between laboratory biomarkers and clinical outcomes. Our study investigates the association between myocardial injury as assessed by increased troponin levels and its effect on in-hospital outcomes in CO poisoning. A total of 900 sequential charts of patients presenting with CO poisoning between 1 January 2012, and 31 August 2019, at our tertiary center with regional hyperbaric chamber and burn unit, were reviewed. Of the 900, a total of 488 patients had elevated carboxyhemoglobin levels. Of these 488 patients, 119 (24.4%) also had blood troponin levels measured. Patients were stratified based on the presence or absence of myocardial injury as evidenced by highly sensitive serum troponin I (TnI) level &gt; 0.5 ng\/mL to determine if a correlation exists relating to myocardial injury and risk of major adverse events. Mean age was 51.2 years, 58.8% were males, 35.3% were non-White, and 10.1% were intentional CO poisonings. Comorbidities included hypertension: 37%, diabetes: 21%, smoking: 21%, hyperlipidemia: 17.6%, coronary artery disease: 11.8%, asthma: 5.9%, heart failure: 5%, atrial fibrillation: 4.2%, and chronic obstructive pulmonary disease: 4.2%. Myocardial injury occurred in 22 patients (18.5%) and was associated with increased likelihood of requiring intensive care admission (54.5% vs. 20.6%, p = 0.002) and intubation (40.9% vs. 14.4%, p = 0.008). TnI elevation was associated with higher in-hospital mortality (p = 0.008, OR 21.3) compared to patients without TnI elevation. Older age was independently associated with increased in-hospital mortality (p = 0.03, OR 1.08). When controlling for age, in-hospital mortality remained statistically significant (p = 0.01, OR 21.37). No significant difference was found with respect to age, comorbidities, gender, race, ethnicity, or hospital length of stay in patients with and without myocardial injury. Myocardial injury induced by CO exposure occurs frequently and adversely affects clinical outcomes. Further research is needed to help guide physicians in the management of CO poisoning and associated myocardial injury to improve patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm12175529","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T08:42:20Z","timestamp":1692952940000},"page":"5529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The Clinical Association between Carbon Monoxide Poisoning and Myocardial Injury as Measured by Elevated Troponin I Levels"],"prefix":"10.3390","volume":"12","author":[{"given":"Bhakti","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY 11549, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jideofor","family":"Omeh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Tackling","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohun","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY 11549, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5178-658X","authenticated-orcid":false,"given":"Tiffany","family":"Sahadeo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY 11549, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viliane","family":"Villcant","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tashina","family":"Dussie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirette","family":"Atnas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofek","family":"Hai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9737-7266","authenticated-orcid":false,"given":"Roman","family":"Zeltser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY 11549, USA"},{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-7230","authenticated-orcid":false,"given":"Amgad N.","family":"Makaryus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY 11549, USA"},{"name":"Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,25]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2023, May 20). Carbon Monoxide (CO) Poisoning Prevention. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/nceh\/features\/copoisoning\/index.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e007267","DOI":"10.1161\/CIRCHEARTFAILURE.120.007267","article-title":"Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning","volume":"14","author":"Huang","year":"2021","journal-title":"Circ. Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1164\/rccm.201606-1275CI","article-title":"Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy","volume":"195","author":"Rose","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.toxrep.2020.01.005","article-title":"Carbon monoxide poisoning","volume":"7","author":"Kinoshita","year":"2020","journal-title":"Toxicol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/j.jacc.2005.01.044","article-title":"Cardiovascular manifestations of moderate to severe carbon monoxide poisoning","volume":"45","author":"Satran","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/j.clinbiochem.2012.06.004","article-title":"Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning","volume":"45","author":"Lippi","year":"2012","journal-title":"Clin. Biochem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jfma.2018.09.005","article-title":"Outcome and prognostic factors of patients treated in the intensive care unit for carbon monoxide poisoning","volume":"118","author":"Liao","year":"2019","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e15151","DOI":"10.1097\/MD.0000000000015151","article-title":"Non-ST elevation myocardial infarction induced by carbon monoxide poisoning: A case report","volume":"98","author":"Gao","year":"2019","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1177\/014107680109400604","article-title":"Carbon monoxide poisoning","volume":"94","author":"Blumenthal","year":"2001","journal-title":"J. R. Soc. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1136\/hrt.2005.071282","article-title":"Differential diagnosis of elevated troponins","volume":"92","author":"Korff","year":"2006","journal-title":"Heart"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1503\/cmaj\/051291","article-title":"Troponin: The biomarker of choice for the detection of cardiac injury","volume":"173","author":"Babuin","year":"2005","journal-title":"CMAJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"H2409","DOI":"10.1152\/ajpheart.01368.2005","article-title":"Carbon monoxide contributes to hypotension-induced cerebrovascular vasodilation in piglets","volume":"291","author":"Kanu","year":"2006","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0021-9150(78)90148-X","article-title":"Carbon monoxide-induced arterial wall hypoxia and atherosclerosis","volume":"30","author":"Schneiderman","year":"1978","journal-title":"Atherosclerosis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1056\/NEJM199811263392206","article-title":"Carbon monoxide poisoning","volume":"339","author":"Ernst","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1001\/jama.295.4.398","article-title":"Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning","volume":"295","author":"Henry","year":"2006","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1177\/1089253211436350","article-title":"Myocardial ischemia reperfusion injury: From basic science to clinical bedside","volume":"16","author":"Frank","year":"2012","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1097\/MJT.0000000000000016","article-title":"Cardiovascular Abnormalities in Carbon Monoxide Poisoning","volume":"25","author":"Garg","year":"2018","journal-title":"Am. J. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.tjem.2015.05.001","article-title":"Analysis of patients presenting to the emergency department with carbon monoxide intoxication","volume":"15","author":"Yurtseven","year":"2016","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.pupt.2009.04.006","article-title":"Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy","volume":"22","author":"Kao","year":"2009","journal-title":"Pulm. Pharmacol. Ther."},{"key":"ref_20","first-page":"e27061","article-title":"COHb Level and High-Sensitivity Cardiac Troponin T in 2012 in Bursa, Turkey: A Retrospective Single-Center Study","volume":"20","author":"Huysal","year":"2016","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.1503\/cmaj.160798","article-title":"Reducing the global burden of sepsis","volume":"189","author":"Dugani","year":"2017","journal-title":"CMAJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"127","DOI":"10.14740\/jocmr3713","article-title":"Effect of Troponin I Elevation on Duration of Mechanical Ventilation and Length of Intensive Care Unit Stay in Patients With Sepsis","volume":"11","author":"Abdalla","year":"2019","journal-title":"J. Clin. Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alatassi, A., Habbal, M., Tamim, H., Sadat, M., Al Qasim, E., and Arabi, Y.M. (2018). Association between troponin-I levels and outcome in critically ill patients admitted to non-cardiac intensive care unit with high prevalence of cardiovascular risk factors. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0515-7"},{"key":"ref_24","first-page":"281701","article-title":"Myocardial Rupture following Carbon Monoxide Poisoning","volume":"2014","author":"Plenta","year":"2014","journal-title":"Case Rep. Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Haliga, R.E., Mor\u0103ra\u0219u, B.C., \u0218orodoc, V., Lionte, C., S\u00eerbu, O., Stoica, A., Ceasovschih, A., Constantin, M., and \u0218orodoc, L. (2022). Rare Causes of Acute Coronary Syndrome: Carbon Monoxide Poisoning. Life, 12.","DOI":"10.3390\/life12081158"},{"key":"ref_26","unstructured":"Mejaddam, A., and DeMoya, M. (2023, May 20). Cardiac Trauma. Critical Care Secrets (Fifth Edition). Available online: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/B9780323085007000849."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0009-8981(96)06436-4","article-title":"Cardiac troponin I and troponin T: Are enzymes still relevant as cardiac markers?","volume":"257","author":"Mair","year":"1997","journal-title":"Clin. Chim. Acta"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1136\/emermed-2012-202152","article-title":"Features and predictors of myocardial injury in carbon monoxide poisoned patients","volume":"31","author":"Cha","year":"2014","journal-title":"Emerg. Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/PEC.0000000000001580","article-title":"Predictors of Severe Clinical Course in Children With Carbon Monoxide Poisoning","volume":"37","author":"Yildiz","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_30","unstructured":"Boyette, L.C., and Manna, B. (2023, May 20). Physiology, Myocardial Oxygen Demand, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499897\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:39:00Z","timestamp":1760128740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,25]]},"references-count":30,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jcm12175529"],"URL":"https:\/\/doi.org\/10.3390\/jcm12175529","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,25]]}}}