Clinical Risk Factors for In‐hospital Adverse Cardiovascular Events After Acute Drug Overdose. (22nd April 2015)

• Record Type: Journal Article
• Authors: Manini, Alex F.; Hoffman, Robert S.; Stimmel, Barry; Vlahov, David; Bird, Steven
• Is Part Of: Academic emergency medicine. Volume 22:Number 5(2015:May)
• Page Start: 499
• Page End: 507
• Publication Date: 2015-04-22
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12658
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" id="acem12658-abs-0001"> <title>Abstract</title> <sec id="acem12658-sec-0001" sec-type="section"> <title>Objectives</title> <p>It was recently demonstrated that adverse cardiovascular events (ACVE) complicate a high proportion of hospitalizations for patients with acute drug overdoses. The aim of this study was to derive independent clinical risk factors for ACVE in patients with acute drug overdoses.</p> </sec> <sec id="acem12658-sec-0002" sec-type="section"> <title>Methods</title> <p>This prospective cohort study was conducted over 3 years at two urban university hospitals. Patients were adults with acute drug overdoses enrolled from the ED. In‐hospital ACVE was defined as any of myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest.</p> </sec> <sec id="acem12658-sec-0003" sec-type="section"> <title>Results</title> <p>There were 1, 562 patients meeting inclusion/exclusion criteria (mean age, 41.8 years; female, 46%; suicidal, 38%). ACVE occurred in 82 (5.7%) patients (myocardial injury, 61; shock, 37; dysrhythmia, 23; cardiac arrests, 22) and there were 18 (1.2%) deaths. On univariate analysis, ACVE risk increased with age, lower serum bicarbonate, prolonged QTc interval, prior cardiac disease, and altered mental status. In a multivariable model adjusting for these factors as well as patient sex and hospital site, independent predictors were: QTc > 500 msec (3.8% prevalence, odds ratio [OR] = 27.6), bicarbonate < 20 mEq/L (5.4% prevalence, OR = 4.4), and prior cardiac disease (7.1% prevalence, OR = 9.5). The derived prediction rule had 51.6% sensitivity, 93.7% specificity, and 97.1% negative predictive value, while presence of two or more risk factors had 90.9% positive predictive value.</p> </sec> <sec id="acem12658-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The authors derived independent clinical risk factors for ACVE in patients with acute drug overdose, which should be validated in future studies as a prediction rule in distinct patient populations and clinical settings.</p> </sec> </abstract>