Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose

Corey Heitz, Alex F. Manini, Robert S. Hoffman, Barry Stimmel, David Vlahov

Research output: Contribution to journalArticle

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 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. 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.

Original languageEnglish (US)
Pages (from-to)500-507
Number of pages8
JournalAcademic Emergency Medicine
Volume22
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Drug Overdose
Odds Ratio
Bicarbonates
Heart Arrest
Heart Diseases
Shock
Urban Hospitals
Wounds and Injuries
Hospitalization
Cohort Studies
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Emergency Medicine

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Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose. / Heitz, Corey; Manini, Alex F.; Hoffman, Robert S.; Stimmel, Barry; Vlahov, David.

In: Academic Emergency Medicine, Vol. 22, No. 5, 01.05.2015, p. 500-507.

Research output: Contribution to journalArticle

Heitz, Corey ; Manini, Alex F. ; Hoffman, Robert S. ; Stimmel, Barry ; Vlahov, David. / Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose. In: Academic Emergency Medicine. 2015 ; Vol. 22, No. 5. pp. 500-507.
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