title: Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.
abstract: Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1st, 2009 and December 31st, 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort. We developed a multivariate logistic model including patient's age, sex, entrance mode and diagnosis as predictors of a composite primary outcome of in-hospital death or ICU admission. A total of 2,747 (4.2%) patients died or were admitted to ICU. The risk of death or ICU admission was mainly associated with the consumption of opioids, followed by cocaine and other narcotics. Particularly, methadone poisoning was associated with a substantial risk (OR: 35.70, 95% CI [26.94-47.32], P < 0.001). In the validation cohort, our model achieved good predictive properties in terms of calibration and discrimination (c-statistic: 0.847). This allows an accurate identification of life-threatening admissions in drug users to support an early and appropriate management.
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.|Laboratory of Clinical Pharmacy, Faculty of Pharmacy, University of Montpellier, Montpellier, France.|Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
authors.forename: Tri-Long
authors.initials: TL
authors.lastname: Nguyen
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.|Department of Biostatistics, Epidemiology, Public Health and Medical Informatics, Nîmes University Hospital, Nîmes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Boudemaghe
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.|Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Leguelinel-Blache
authors.affiliation: Department of Medical Pharmacology and Toxicology, Addictovigilance Centre, Montpellier University Hospital, Montpellier University Hospital, Montpellier, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Eiden
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.|Department of Pharmacy, Nîmes University Hospital, Nîmes, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Kinowski
authors.affiliation: Departments of Anesthesia &Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.|The Perioperative Research Group, Population Health Research Institute, Hamilton, Ontario, Canada.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Manach
authors.affiliation: Laboratory of Clinical Pharmacy, Faculty of Pharmacy, University of Montpellier, Montpellier, France.|Department of Medical Pharmacology and Toxicology, Addictovigilance Centre, Montpellier University Hospital, Montpellier University Hospital, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Peyrière
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France.|Department of Biostatistics, Epidemiology, Public Health and Medical Informatics, Nîmes University Hospital, Nîmes, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Landais
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000633:toxicity*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid