Predicting adverse cardiovascular events in emergency department patients with bupropion overdose.
adverse cardiovascular events
bupropion
cardiotoxicity
overdose
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
11 Jun 2024
11 Jun 2024
Historique:
revised:
02
05
2024
received:
06
03
2024
accepted:
12
05
2024
medline:
12
6
2024
pubmed:
12
6
2024
entrez:
12
6
2024
Statut:
aheadofprint
Résumé
Bupropion toxicity can lead to adverse cardiovascular events (ACVE), but delayed onset of toxicity makes risk stratification difficult. This study aimed to validate previously defined predictors of ACVE and identify novel predictors among patients presenting to the emergency department (ED) after bupropion overdose. This secondary analysis of prospective data from the Toxicology Investigators Consortium Core Registry analyzed adult acute or acute-on-chronic bupropion exposures from 2015 to 2018. The primary outcome was ACVE (any of the following: myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest). Potential predictors of ACVE included previously derived predictors in the overall drug overdose population (prior cardiac disease, initial serum bicarbonate < 20 mEq/L, and initial QTc ≥ 500 ms), exposure circumstances, and initial serum lactate value. Candidate predictors were evaluated using univariate analysis and multivariable regression modeling. Receiver operator characteristic curves were used to derive optimal cutoff points for novel predictors, and prognostic test characteristics were calculated. Of 355 patients analyzed, ACVE occurred in 34 (9.6%) patients. Initial serum bicarbonate < 20 mEq/L (adjusted odds ratio [aOR] 4.42, 95% confidence interval [CI] 1.94-10.0) and initial QTc ≥ 500 ms (aOR 2.52, 95% CI 1.01-6.09) independently predicted ACVE. Exposure circumstances did not predict ACVE. Initial serum lactate > 5.2 mmol/L independently predicted ACVE (aOR 12.2, 95% CI 2.50-75.2) and was 90.7% specific with 80.3% negative predictive value. Metabolic acidosis and QTc prolongation were validated as predictors of ACVE in ED patients with bupropion overdose. Serum lactate elevation was strongly predictive of ACVE in this study and warrants further investigation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NHLBI NIH HHS
ID : T32HL155020
Pays : United States
Organisme : NIDA NIH HHS
ID : R01DA037317
Pays : United States
Organisme : NIDA NIH HHS
ID : R01DA048009
Pays : United States
Informations de copyright
© 2024 Society for Academic Emergency Medicine.
Références
Injury facts. Deaths by age and cause–Data details. Accessed August 14, 2023. https://injuryfacts.nsc.org/all‐injuries/deaths‐by‐demographics/deaths‐by‐age/data‐details/
CDC WONDER: Multiple Cause of Death 1999–2021. Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed August 14, 2023. wonder.cdc.gov
DOSE Dashboard: Nonfatal Overdose Syndromic Surveillance Data. Centers for Disease Control and Prevention. Accessed August 17, 2023. https://www.cdc.gov/overdose‐prevention/data‐research/facts‐stats/dose‐dashboard‐nonfatal‐surveillance‐data.html
Manini AF, Nelson LS, Stimmel B, Vlahov D, Hoffman RS. Incidence of adverse cardiovascular events in adults following drug overdose. Acad Emerg Med. 2012;19(7):843‐849.
Manini AF, Hoffman RS, Stimmel B, Vlahov D. Clinical risk factors for in‐hospital adverse cardiovascular events after acute drug overdose. Acad Emerg Med. 2015;22(5):499‐507.
Wellbutrin (bupropion hydrochloride). 2017 Research Triangle Park, NC: GlaxoSmithKline. Accessed April 15, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018644s043lbl.pdf
Shrier M, Díaz JE, Tsarouhas N. Cardiotoxicity associated with bupropion overdose. Ann Emerg Med. 2000;35(1):100.
Givens ML, Gabrysch J. Cardiotoxicity associated with accidental bupropion ingestion in a child. Pediatr Emerg Care. 2007;23(4):234‐237.
Franco V. Wide complex tachycardia after bupropion overdose. Am J Emerg Med. 2015;33(10):1540.e3‐1540.e5.
Herrman NWC, Kalisieski MJ, Fung C. Bupropion overdose complicated by cardiogenic shock requiring vasopressor support and lipid emulsion therapy. J Emerg Med. 2020;58(2):e47‐e50.
Simpson M, Troger A, Feng C, Whitledge JD, Monuteaux M, Burns MM. Clinical and electrocardiographic factors associated with adverse cardiovascular events in bupropion exposures. Clin Toxicol. 2023;61(7):529‐535.
2021 annual report of the National Poison Data System© (NPDS) from America's poison centers: 39th annual report. Clin Toxicol. 2022;60(12):1381‐1643.
Chhabra N, DesLauriers C, Wahl M, Bryant SM. Management of severe bupropion poisoning with intravenous lipid emulsion. Clin Toxicol. 2018;56(1):51‐54.
Fulton LV, Fabich RA, Bhatta J, et al. Comparison of resuscitative protocols for bupropion overdose using lipid emulsion in a swine model. Mil Med. 2016;181(5):482‐487.
Cole JB, Douglas S, Prekker M, Driver B, Holsing L, Olives T. North American Congress of Clinical Toxicology (NACCT) 2023. Clin Toxicol. 2023;61(Sup 2):1‐186. 10.1080/15563650.2023.2233835
Spyres MB, Farrugia LA, Kang AM, et al. The toxicology investigators consortium case registry–the 2018 annual report. J Med Toxicol. 2019;15(4):228‐254.
Brush JE, Kaul S, Krumholz HM. Troponin testing for clinicians. J Am Coll Cardiol. 2016;68(21):2365‐2375.
Gupta V, Paranzino M, Alnabelsi T, et al. 5th generation vs 4th generation troponin T in predicting major adverse cardiovascular events and all‐cause mortality in patients hospitalized for non‐cardiac indications: a cohort study. PLoS One. 2021;16(2):e0246332.
Manini AF, Nelson LS, Skolnick AH, Slater W, Hoffman RS. Electrocardiographic predictors of adverse cardiovascular events in suspected poisoning. J Med Toxicol. 2010;6(2):106‐115.
Carreiro S, Miller S, Wang B, Wax P, Campleman S, Manini AF. Clinical predictors of adverse cardiovascular events for acute pediatric drug exposures. Clin Toxicol. 2020;58(3):183‐189.
Manini AF, Nair AP, Vedanthan R, Vlahov D, Hoffman RS. Validation of the prognostic utility of the electrocardiogram for acute drug overdose. J Am Heart Assoc. 2017;6(2):e004320.
Brady JE, Giglio R, Keyes KM, DiMaggio C, Li G. Risk markers for fatal and non‐fatal prescription drug overdose: a meta‐analysis. Inj Epidemiol. 2017;4(1):24.
Kratz A, Ferraro M, Sluss PM, Lewandrowski KB. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Laboratory reference values. N Engl J Med. 2004;351(15):1548‐1563.
Cheung R, Hoffman RS, Vlahov D, Manini AF. Prognostic utility of initial lactate in patients with acute drug overdose: a validation cohort. Ann Emerg Med. 2018;72(1):16‐23.
van Smeden M, de Groot JAH, Moons KGM, et al. No rationale for 1 variable per 10 events criterion for binary logistic regression analysis. BMC Med Res Methodol. 2016;16(1):163.
Austin PC, Steyerberg EW. The number of subjects per variable required in linear regression analyses. J Clin Epidemiol. 2015;68(6):627‐636.
Al‐Abri SA, Orengo JP, Hayashi S, Thoren KL, Benowitz NL, Olson KR. Delayed bupropion cardiotoxicity associated with elevated serum concentrations of bupropion but not hydroxybupropion. Clin Toxicol. 2013;51(10):1230‐1234.
Heise CW, Skolnik AB, Raschke RA, Owen‐Reece H, Graeme KA. Two cases of refractory cardiogenic shock secondary to bupropion successfully treated with veno–arterial extracorporeal membrane oxygenation. J Med Toxicol. 2016;12(3):301‐304.
Starr P, Klein‐Schwartz W, Spiller H, Kern P, Ekleberry SE, Kunkel S. Incidence and onset of delayed seizures after overdoses of extended‐release bupropion. Am J Emerg Med. 2009;27(8):911‐915.