Predicting Adverse Cardiovascular Events in Emergencies Due to Drug Overdose

描述（由申请人提供）：这个指导以患者为导向的研究职业发展奖（K23）的目的是帮助亚历克斯·曼尼尼，医学博士成为药物过量紧急情况下的独立研究科学家。在大卫弗拉霍夫博士（导师）的指导下，他将与有成就的研究人员合作，研究药物过量的不良心血管事件（ACVE），建立在令人兴奋的初步数据基础上。培训活动包括哥伦比亚梅尔曼公共卫生学院的统计学和流行病学课程;西奈山医学院的成瘾培训计划;药物过量，流行病学和心脏病学的重点指导;以及在区域，国家和国际会议上介绍中期结果。建议对药物过量的急诊科患者进行预后指标研究，以评估院内ACVE的发生率。基于初步数据，假设是临床风险因素（例如，人口统计学、暴露意图、心电图）将独立预测院内ACVE。具体目标是：（1）确定药物过量患者ACVE的发生率;（2）确定药物过量患者院内ACVE的预后指标;（3）根据上述ACVE预后指标推导出一个简单的风险分层评分系统，并测试风险评分的诊断特征，以辅助急性药物过量患者的临床决策。为了实现这些目标，将前瞻性招募两家城市教学医院的药物过量急诊科患者，并对其进行纵向随访，以了解院内ACVE的发生情况。将使用中毒严重程度评分、急性生理学和慢性健康评价以及裁定的ACVE终点评估药物过量严重程度。将由设盲的心脏病专家对入院心电图进行解读，并评价血清的毒理学筛查和心脏生物标志物。ACVE的预后指标将被推导出来，并纳入一个简单的风险评分，选择一个临界点，以实现最佳的诊断测试特征。实施这种风险分层工具有可能预防AGVE并发症，美国每年约有150万次与药物相关的急诊就诊。 公共卫生相关性：药物过量和处方药滥用影响不同的人口统计学、种族/民族和经济阶层。在美国，中毒是伤害相关死亡的第二大原因，也是40岁以下患者心脏骤停的主要原因。在美国，每年有240万例中毒报告和大约150万例与毒品有关的紧急情况。

DESCRIPTION (provided by applicant): The purpose of this mentored patient-oriented research career development award (K23) is to assist Alex Manini, MD to become an independent research scientist in drug overdose emergencies. Guided by Dr. David Vlahov (mentor), he will collaborate with accomplished investigators to study adverse cardiovascular events (ACVE) in drug overdose, building upon exciting preliminary data. Training activities include courses in statistics and epidemiology at the Columbia Mailman School of Public Health; the Addiction Training program at Mount Sinai School of Medicine; focused mentorship in drug overdose, epidemiology, and cardiology; and presentation of interim results at regional, national, and international conferences. Proposed is a prognostic indicator study of emergency department patients with drug overdose to evaluate occurrence of in-hospital ACVE. Based on preliminary data, the hypothesis is that clinical risk factors (e.g., demographics, exposure intent, electrocardiogram) will independently predict in-hospital ACVE. The specific aims are: (1) to determine the incidence of ACVE in patients with drug overdose; (2) to identify prognostic indicators for in-hospital ACVE in patients with drug overdose; and (3) to derive a simple risk stratification scoring system based on the above prognostic indicators for ACVE and to test the diagnostic characteristics of the risk score to aid clinical decision-making for patients with acute drug overdose. To meet these aims, emergency department patients with drug overdose at two urban teaching hospitals will be prospectively enrolled and followed longitudinally for occurrence of in-hospital ACVE. Overdose severity will be assessed with Poison Severity Scores, Acute Physiology and Chronic Health Evaluation, and adjudicated ACVE endpoints. Interpretation of the admission electrocardiogram will be performed by a blinded cardiologist, and serum will be evaluated for toxicology screens and cardiac biomarkers. Prognostic indicators for ACVE will be derived and incorporated into a simple risk score with a cutpoint chosen to achieve optimal diagnostic test characteristics. Implementation of this risk stratification tool has the potential to prevent AGVE complications for an estimated 1.5 million drug-related emergency department visits in the U.S. annually. PUBLIC HEALTH RELEVANCE: Drug overdose and prescription drug abuse affect diverse demographics, races/ethnicities, and economic classes. Poisoning is the second leading cause of injury-related fatality in the U.S., and the leading cause of cardiac arrest in victims under 40 years of age. There are 2.4 million reported poison exposures and approximately 1.5 million drug-related emergencies in the U.S. annually.