Role of aspartate aminotransferase in predicting Pediatric carbon monoxide poisoning outcomes: a Multicenter retrospective cohort study

This multicenter retrospective cohort study investigated prognostic markers for clinical outcomes and delayed neurological sequelae (DNS) in pediatric patients with carbon monoxide poisoning (COP). We analyzed data from patients under 17 yr of age who presented to emergency departments between January 2007 and October 2018 with a carboxyhemoglobin (COHb) level exceeding 10%. A total of 162 cases were included. Clinical and laboratory parameters such as oxygen saturation (SpO₂), Glasgow Coma Scale (GCS), white blood cell (WBC) count, aspartate aminotransferase (AST), red cell distribution width (RDW), and COHb levels were evaluated. Poor outcomes were defined as death or a GCS score below 13 at discharge. Patients with poor outcomes had significantly lower SpO₂ and GCS scores, and elevated WBC, AST, and RDW levels (all P < 0.001). Among these biomarkers, AST had the highest area under the receiver operating characteristic curve (AUC = 0.879), and an AST cut-off value of 38.5 U/L yielded a sensitivity of 81.25% (95% CI: 54.35%–95.95%) and specificity of 87.10% (95% CI: 79.89%–92.44%) for predicting poor outcomes. Of the 148 patients with follow-up data, 10 developed DNS. These patients had significantly higher COHb levels (P = 0.032) and lower GCS scores at discharge (p = 0.002). Our findings suggest that AST is a strong and accessible biomarker for predicting poor outcomes in pediatric COP and may assist clinicians in early risk stratification and management.