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Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin: a forensic retrospective study in
Zheng Liu1, Hang Meng2, Juntian Huang1
1Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Shanghai, 200032, China.
Insights
Carbon monoxide (CO) poisoning deaths with low carboxyhemoglobin (COHb) levels are often linked to fire circumstances and outdoor environments, affecting all age groups. Further research is needed to identify diagnostic markers for these cases.
Area of Science:
- Forensic Toxicology
- Environmental Health
- Public Health
Background:
- Carbon monoxide (CO) poisoning is a significant global cause of mortality.
- Understanding CO poisoning with low carboxyhemoglobin (COHb) levels is crucial for accurate forensic analysis.
- Existing research often focuses on higher COHb levels, leaving characteristics of low COHb cases under-explored.
Purpose of the Study:
- To characterize the epidemiological, demographic, and forensic features of CO poisoning cases, with a specific focus on those with low COHb levels.
- To differentiate the circumstances surrounding CO poisoning based on varying COHb concentrations.
- To investigate the role of alcohol and other substances in CO poisoning cases with different COHb levels.
Main Methods:
- Analysis of 307 CO poisoning cases from Shanghai Public Security Bureau records.
- Categorization of cases into three groups based on COHb levels: 10-30%, 30-50%, and ≥50%.
- Examination of epidemiological data, demographic information, and forensic findings, including circumstances of death (fire, gas leakage, location) and presence of alcohol or drugs.
Main Results:
- CO poisoning with COHb levels <30% showed no age preference, unlike higher COHb groups predominantly affecting younger individuals.
- Low COHb% cases (10-30%) were more frequently associated with fire circumstances and outdoor locations compared to higher COHb% cases.
- Alcohol consumption was linked to higher COHb% in fire-unrelated cases, but not in fire-related ones. Five cases with extremely low COHb% (<30%) had no cardiopulmonary pathology or psychoactive substances detected.
Conclusions:
- CO poisoning with low COHb% (<30%) is significantly associated with fire incidents and outdoor environments, affecting all age groups.
- The findings highlight the need for improved diagnostic markers to accurately assess CO poisoning, especially in cases with unexpectedly low COHb levels.
- Distinguishing features of low COHb% CO poisoning are critical for forensic investigations and legal proceedings.
Abstract:
Carbon monoxide (CO) poisoning is a common cause of death, leading to morbidity and mortality worldwide. Features of the CO poisoning with low carboxyhemoglobin (COHb) levels remain to be characterized. This study collected a total of 307 CO poisoning cases from Shanghai Public Security Bureau, an official organization that handles the most complicated and life-threatening cases across Shanghai municipality in China, and regrouped these cases into three categories: group 1, 10% < COHb% < 30% (n = 58); group 2, 30% ≤ COHb% < 50% (n = 79); group 3, COHb% ≥ 50% (n = 170). Epidemiological, demographic, and forensic aspects of the CO poisoning cases, particularly those with low COHb levels, were analyzed. Our results showed that group 2 and 3 were mostly observed in younger victims (≤ 30 years), while group 1 equally distributed to all age groups (p = 0.03). All the CO poisoning from group 2 and 3 occurred in enclosed spaces, whereas cases from group 1 died additionally in outdoor spaces (p = 0.01). 81.03% of group 1 cases died in fire circumstances, while only 45.57% from group 2 and 30.59% from group 3 were fire-related (p = 0.00). Accordingly, group 1 was mostly related with fire burns, while group 2 or 3 were largely associated with gas leakage (p = 0.00). A combination with alcohol, but not other psychotropic drugs, associated with significant higher levels of blood COHb% in fire-unrelated (p = 0.021) but not fire-related cases (p = 0.23). Five extremely low COHb% (< 30%)-related poisoning deaths were negative of any cardiopulmonary pathology and psychoactive substances. In conclusion, CO poisoning with low COHb% significantly associates with fire circumstances and outdoor spaces and has no age preference. Further diagnostic markers mandates to be identified in order to avoid disputes in cases of extremely low COHb%-related poisoning.
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