Utility of Cardiac Troponin to Predict Drug Overdose Mortality

Abstract

Drug overdose is now the leading cause of injury-related mortality in the USA, but the prognostic utility of cardiac biomarkers is unknown. We investigated whether serum cardiac troponin I (cTnI) was associated with overdose mortality. This prospective observational cohort studied adults with suspected acute drug overdose at two university hospital emergency departments (ED) over 3 years. The endpoint was in-hospital mortality, which was used to determine test characteristics of initial/peak cTnI. There were 437 overdoses analyzed, of whom there were 20 (4.6 %) deaths. Mean initial cTnI was significantly associated with mortality (1.2 vs. 0.06 ng/mL, p <0.001), and the ROC curve revealed excellent cTnI prediction of mortality (AUC 0.87, CI 0.76–0.98). Test characteristics for initial cTnI (90 % specificity, 99 % negative predictive value) were better than peak cTnI (88.2 % specificity, 99.2 % negative predictive value), and initial cTnI was normal in only one death out of the entire cohort (1/437, CI 0.1–1.4 %). Initial cTnI results were highly associated with drug overdose mortality. Future research should focus on high-risk overdose features to optimize strategies for utilization of cTnI as part of the routine ED evaluation for acute drug overdose.

Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents

“…High troponin levels have been reported to be associated with an increased mortality risk in acute drug poisoning, [30] although this finding could not be corroborated by our model. However, the number of patients with readings above the normal range may not have been sufficiently large to detect any evidence of this association after acute exposure to heterogeneous drugs and nonpharmaceutical agents.…”

Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose

“…Myocardial injury is the most common ACVE that occurs because of drug overdose . Serum cardiac troponin I is a useful biomarker for drug toxicity . According to guidelines from the American Heart Association, the approach to patients with symptoms of drug‐induced myocardial injury should differ in both diagnostic and therapeutic management .…”

“…3,16 Serum cardiac troponin I is a useful biomarker for drug toxicity. [17][18][19] According to guidelines from the American Heart Association, the approach to patients with symptoms of drug-induced myocardial injury should differ in both diagnostic and therapeutic management. 14 However, such guidelines currently rely upon expert consensus on the role of the ECG and cardiac biomarkers because of a previous lack of evidencebased tools to risk-stratify and guide management.…”

Usefulness of Transthoracic Echocardiography Parameters and Brain Natriuretic Peptide as Mortality Predictors in Hospitalized Acutely Poisoned Patients: A Prospective Observational Study

“…We consider that only the acute effect of the poison on the heart, either direct toxicity, or subsequent to metabolic alterations, explained the changes in BNP level, which was correlated with the presence of left ventricular dysfunction, and with death. Brain natriuretic peptide might be added to troponin, which was strongly associated with in-hospital mortality in a cohort of adults with acute drug overdoses [27], in the initial evaluation of a poisoned patient.…”