Clinical Risk Factors for In‐hospital Adverse Cardiovascular Events After Acute Drug Overdose

Abstract

Objectives 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. Methods 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. Results 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 mEql/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. Conclusions 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.

Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors

“…This study was a secondary analysis of data collected from a prospective cohort of adult ED patients with acute drug overdose at two urban tertiary-care hospitals over a 5-year period (2009-13) (6). These EDs have a combined annual visit volumes in excess of 150,000 and are staffed 24 hours per day with board certified emergency physicians and intensivists.…”

“…The screening, inclusion, and exclusion criteria have recently been described elsewhere (6). Briefly, patients were included who met both of the following criteria: (A) acute presentation (within 24 hours of exposure); and (B) suspected overdose (i.e., illicit drug dose sufficient to cause symptoms or any prescription drug exposure greater than its therapeutic dose).…”

“…The original (primary) data analysis for this cohort was adverse cardiovascular events, which has previously been reported (6). ETI was counted regardless of rapid sequence induction, and excluded non-invasive ventilation.…”

Acute salicylate poisoning: risk factors for severe outcome

“…12,13 The study protocol was approved by the Institutional Review Board (IRB) for the two participating institutions with a waiver of informed consent.…”

Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status

“…This study was a secondary data analysis from a prospective cohort of acute emergency department (ED) visits for DRAMS at one urban tertiary care hospital [12,13]. Consecutive adult (≥18 years of age) drug-related ED visits were initially screened for inclusion by trained research assistants who were physically present in the ED during normal business hours; additionally, they also screened all ED consults to the regional Poison Control Center (PCC) 24 h/day and 7 days/week from May 2009 through September 2010.…”