Predicting Adverse Cardiovascular Events in Emergencies Due to Drug Overdose

描述（由申请人提供）：这个以患者为导向的研究职业发展奖（K23）的目的是帮助医学博士亚历克斯·马尼尼（Alex Manini）成为药物过量紧急情况的独立研究科学家。在 David Vlahov 博士（导师）的指导下，他将与经验丰富的研究人员合作，以令人兴奋的初步数据为基础，研究药物过量导致的不良心血管事件 (ACVE)。培训活动包括哥伦比亚梅尔曼公共卫生学院的统计和流行病学课程；西奈山医学院的成瘾训练计划；重点指导药物过量、流行病学和心脏病学；并在区域、国家和国际会议上介绍中期结果。提议对急诊科药物过量​​患者进行预后指标研究，以评估院内 ACVE 的发生情况。根据初步数据，假设临床危险因素（例如人口统计、暴露意图、心电图）将独立预测院内 ACVE。具体目的是：（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)基于上述ACVE预后指标推导出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，将前瞻性地招募两家城市教学医院的急诊科药物过量​​患者，并纵向随访院内 ACVE 的发生情况。过量严重程度将通过中毒严重程度评分、急性生理学和慢性健康评估以及裁定的 ACVE 终点进行评估。入院心电图的解读将由一位盲法心脏病专家进行，并对血清进行毒理学筛查和心脏生物标志物评估。 ACVE 的预后指标将被导出并纳入一个简单的风险评分中，并选择一个切点来实现最佳的诊断测试特征。在美国，每年估计有 150 万人次因毒品相关的急诊就诊，实施这一风险分层工具有可能预防 AGVE 并发症。 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、种族/民族和经济阶层。中毒是美国伤害相关死亡的第二大原因，也是 40 岁以下受害者心脏骤停的主要原因。美国每年报告 240 万起中毒事件和大约 150 万起与毒品相关的紧急情况。

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.