COGAS score helps assess neurocognitive outcomes in patients with CO poisoning: JAMA

A new study published in Journal of American Medical Association suggest that during the early stages of carbon monoxide (CO) poisoning, measuring the Glasgow Coma Scale score, age, and shock (COGAS score) may assist identify individuals at risk of poor neurocognitive sequelae.

A fundamental objective of treating acute CO poisoning is to prevent neurocognitive sequelae. There are no good score systems for predicting the likelihood of these consequences. Sung Hwa Kim and colleagues conducted this work to design and verify a unique clinical grading model that can predict poor neurocognitive outcomes following acute co poisoning.

This prognostic analysis includes derivation and validation cohorts relying on sequential patient data gathered prospectively at university hospitals in Wonju, Republic of Korea, from January 2006 to July 2021, and in Incheon, Republic of Korea, from August 2016 to June 2020. Participants comprised those aged 16 and above who had been diagnosed with co poisoning. The data was examined from October 2021 until January 2022. The neurocognitive sequelae at 4 weeks following co poisoning were of particular attention. In the derivation cohort, logistic regression models were employed to uncover predictors of poor neurocognitive outcomes. At one month following CO-exposure, outcomes were assessed using the Global Deterioration Scale [GDS] and categorized as excellent (1-3 points) or bad (4-7 points).

The key findings of this study were as follow:

1. A total of 1282 individuals were evaluated, including 1016 in the generation cohort and 266 in the validation group.

2. In the derivation cohort, 126 patients (12.4%) had low GDS scores.

3. With 1-year follow-up data, 757 (86.1%) of the 879 patients in the derivation cohort had stable GDS scores, 102 (11.6%) had better GDS scores, and 20 (2.3%) had worsening GDS scores.

4. Age greater than 50 years (1 point), Glasgow Coma Scale score of 12 or less (1 point), serum creatine kinase level greater than 320 U/L at emergency department presentation (1 point), shock (1 point), and no use of hyperbaric oxygen therapy (1 point) stayed factors associated significantly with worse outcome in the final prediction model; thus, this scoring system was named COGAS.

5. The derivation cohort's area under the receiver operating characteristic curve for COGAS score was 0.862, whereas the validation cohort's was 0.870.

In conclusion, this rating system performed quite well in predicting poor neurocognitive outcomes. Future research is needed to verify the COGAS score in different ethnic groups and for other therapeutic uses.

Reference:

Kim SH, Lee Y, Kang S, Paik JH, Kim H, Cha YS. Derivation and Validation of a Score for Predicting Poor Neurocognitive Outcomes in Acute Carbon Monoxide Poisoning. JAMA Netw Open. 2022;5(5):e2210552. doi:10.1001/jamanetworkopen.2022.10552