title: 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.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Box 1620, One Gustave Levy Place, New York, NY, 10029, USA. alex.manini@mssm.edu.|Elmhurst Hospital Center, New York, NY, 11373, USA. alex.manini@mssm.edu.
authors.forename: Alex F
authors.identifier: http://orcid.org/0000-0001-8276-9320
authors.initials: AF
authors.lastname: Manini
authors.affiliation: Cardiology Division, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Stimmel
authors.affiliation: Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA.|New York City Poison Control Center, Department of Health and Mental Hygiene, New York City, NY, 10016, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: School of Nursing, University of California, San Francisco, CA, 94143, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D066126:Cardiotoxicity; D062787:Drug Overdose / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D009519:New York City; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Biomarker; Drug; Mortality; Overdose; Troponin