Predicting Adverse Cardiovascular Events in Emergencies Due to Drug Overdose

描述（由申请人提供）：这个以指导患者为导向的研究职业发展奖（K23）的目的是帮助医学博士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，他将与有成就的研究人员合作，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；西奈山医学院的戒毒培训项目；在药物过量、流行病学和心脏病学方面提供重点指导；并在区域、国家和国际会议上介绍中期结果。建议对急诊科药物过量患者进行预后指标研究，评价院内ACVE的发生情况。根据初步数据，假设临床危险因素（如人口统计学、暴露意图、心电图）将独立预测院内ACVE。具体目的是：(1)确定药物过量患者中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，得出简单的风险分层评分体系，检验风险评分的诊断特点，为急性药物过量患者的临床决策提供依据。为了达到这些目的，我们前瞻性地招募了两所城市教学医院的急诊科药物过量患者，并对院内ACVE的发生进行了纵向随访。用药过量严重程度将通过中毒严重程度评分、急性生理和慢性健康评估以及判定的ACVE终点来评估。入院心电图的解释将由盲法心脏病专家执行，血清将被评估毒理学筛查和心脏生物标志物。ACVE的预后指标将被导出并纳入一个简单的风险评分，并选择一个切点来实现最佳的诊断测试特征。在美国，每年约有150万例与药物相关的急诊科就诊，实施这种风险分层工具有可能预防AGVE并发症。

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.