Utility of Cardiac Troponin to Predict Drug Overdose Mortality

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

    Research output: Contribution to journalArticlepeer-review

    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.

    Original languageEnglish (US)
    Pages (from-to)355-360
    Number of pages6
    JournalCardiovascular Toxicology
    Volume16
    Issue number4
    DOIs
    StatePublished - Oct 1 2016

    Keywords

    • Biomarker
    • Drug
    • Mortality
    • Overdose
    • Troponin

    ASJC Scopus subject areas

    • Molecular Biology
    • Toxicology
    • Cardiology and Cardiovascular Medicine

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