Determination of netrin-1 levels and its relationship with neurotoxicity in carbon monoxide poisoning

Objective: The aim of the study was to assess netrin-1 levels in carbon monoxide (CO) poisoning to determine its relationship with poisoning severity and neurotoxicity. Methods: This is a cross-sectional prospective study. The patients older than 18 years with CO poisoning were included. The patients were categorized into two groups on the basis of neurological involvement. Both the patient and the control groups were sampled for netrin-1 at 0th hour, and the patient group only was sampled for netrin-1 at 4th hour. Results: A total of 84 patients and 50 healthy controls were enrolled. The median 0th hour netrin-1 level of the patient group (765.1 pg/mL (619.8-983.1) was significantly higher than the control group (484 pg/mL (376-1031.6)) (p < 0.001). There was also a significant difference between the 0th hour and 4th hour netrin-1 (888.9 pg/mL (700.3-1175.5)) levels in the patient group (p < 0.001).There was no significant statistical difference between patients with and without neurological involvement (p = 0.62) and between those who underwent hyperbaric oxygen therapy (HBOT) and those who did not (p = 0.76) with respect to 4th hour netrin-1 levels. Conclusion: The significantly higher netrin-1 levels in patients with CO poisoning, suggests that netrin-1 is elevated as a stress marker. Although there is no significant difference in netrin-1 levels in patients with neurological impairment in CO poisonings, netrin-1 may show subclinically neurological effects. Hence, we believe that netrin-1 cannot be used as a marker of poisoning severity.