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ALCOPOP is a prospective cohort study entitled "Predicitve Value of Copeptin in CO-intoxicated Patients". The primary objective of this study is to assess the independent association between early Copeptin and / or Troponin concentrations at presentation at the emergency department with disability-free survival after carbon monoxide (CO) -intoxication. Further secondary aims are to determine the independent association between early postoperative Copeptin and / or Troponin concentrations and major adverse cardiovascular events (MACE), mortality and long-term neurological outcome.
Adult patients with acute CO-intoxication (CO-hemoglobin >10%) will be included. Main exposure will be Copeptin and Troponin concentrations. Primary endpoint will be disability-free survival at 90 days. The investigators assume to include 120 patients in 24 months
Aims of the study
To evaluate early Copeptin at arrival at emergency department based on the following:
To evaluate early Troponin at arrival at emergency department in terms of:
The initial patient visit will take place after screening of patients and eligibility assessment and no later than on the day after admission to the emergency department (day +1). After provision of patient information and written informed consent, baseline data will be extracted from clinical source documents. The investigators plan to sample blood upon arrival in the emergency department (Troponin and Copeptin), and on day 1 and 2 after CO-intoxication (Troponin). Another blood sample will be carried out after hyperbaric oxygen (HBO) therapy to obtain a a second Copeptin measurement. Sampling will occur as far as possible concurrently to clinically indicated blood samples. Blood samples will be analyzed in a certified laboratory.
The investigators will contact all patients after 30 days and 90 days by postal mail and/or phone call (personnel blinded to biomarkers concentrations) to obtain for the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 and information on potential events. In case of the report of potential endpoints, the patient's general practitioner and/or treating hospital will be contacted for more detailed information and source documents for MACE, persistent neurological sequelae (PNS) and delayed neurological sequela (DNS) adjudication. Adjudicators will be trained in the study definitions and blinded to biomarkers concentrations.
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| Measure | Description | Time Frame |
|---|---|---|
| disability-free survival | Disability is defined as a persistent impairment in health status, as measured by the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 score, of at least 24 points when using response scores of 1-5 for each item, reflecting a disability level of at least 25% and being the threshold point between 'disabled' and 'not disabled' as per WHO guideline. | 90 days |
| Measure | Description | Time Frame |
|---|---|---|
| Disability-free survival at 30 days after CO-intoxication | Disability is defined as a persistent (at least 1 month) impairment in health status, as measured by the 12-item WHODAS 2.0 score, of at least 24 points when using response scores of 1-5 for each item, reflecting a disability level of at least 25% and being the threshold point between 'disabled' and 'not disabled' as per WHO guideline. | 30 days |
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Inclusion Criteria:
Exclusion Criteria:
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The University Hospital Duesseldorf is one of three centres for hyperbaric oxygen therapy (HBO) in western Germany treating about 60-100 patients with CO-intoxication annually. we will screen each patient with CO-intoxication admitted to the emergency department of the Univerisity Hospital Duesseldorf.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dr. Alexandra Stroda | Contact | +49 211 8118102 | alexandra.stroda@med.uni-duesseldorf.de |
| Name | Affiliation | Role |
|---|---|---|
| PD Stephan Sixt | Department of Anaesthesiology, University Hospital Duesseldorf | Principal Investigator |
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| ID | Term |
|---|---|
| D002249 | Carbon Monoxide Poisoning |
| ID | Term |
|---|---|
| D005739 | Gas Poisoning |
| D011041 | Poisoning |
| D064419 | Chemically-Induced Disorders |
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Whole blood
| WHODAS 2.0 Score at 30 and 90 days after CO-intoxication | 12-item WHODAS 2.0 score | 30 and 90 days |
| Days alive and out of hospital at 30 days and 90 days after CO-intoxication | patient centred outcome; amount of days spent at home after CO-intoxication | 30 and 90 days |
| MACE at 30 days and 90 days | defined as non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure or transfer to a higher unit of care, atrial fibrillation or stroke | 30 and 90 days |
| All-cause mortality at 30 days and 90 days | mortality after CO-intoxication independent of its cause | 30 and 90 days |
| Length of hospital stay | amount of days spent at hospital | from admission (day informed consent was given) until day of hospital discharge of the respective participant, up to 90 days |
| Length of ICU-stay | amount of days spent at ICU | from admission (day informed consent was given) until day of hospital discharge of the respective participant, up to 90 days |
| Persistent neurological sequelae (PNS) at 30 days and 90 days measured by a questionnaire | Symptoms or signs attributable to CO poisoning that are evident immediately following poisoning including subtle personality changes, mood disorders headaches, tiredness, difficulty in concentrating, difficulty in sleeping, visual disorders, and new difficulties with social or professional activities and memory impairment to (much less commonly) focal neurological injuries and other severely disabling manifestations of hypoxic brain injury | 30 days and 90 days |
| Delayed neurological sequelae (DNS) at 30 days and 90 days measured by a questionnaire | Symptoms and signs as mentioned above (see outcome 9) occurring between hospital discharge and follow-up | 30 days and 90 days |