title: Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Manini
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: Cardiology Division, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Barry
authors.initials: B
authors.lastname: Stimmel
authors.affiliation: Office of the Dean, School of Nursing, University of California, San Francisco, CA.
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D062787:Drug Overdose / Q000175:diagnosis / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology