Division of Medical Toxicology, Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York, USA.
Departments of Psychiatry, Neuroscience, and Pharmacological Sciences, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Addict Biol. 2021 Mar;26(2):e12901. doi: 10.1111/adb.12901. Epub 2020 Apr 15.
Overdose of stimulant drugs has been associated with increased risk of adverse cardiovascular events (ACVE), some of which may be ascribed to endothelial dysfunction. The aims of this study were to evaluate biomarkers of endothelial dysfunction in emergency department (ED) patients with acute cocaine overdose and to assess the association between in-hospital ACVE in ED patients with any acute drug overdose. This was a prospective consecutive cohort study over 9 months (2015-2016) at two urban, tertiary-care hospital EDs. Consecutive adults (≥18 years) presenting with suspected acute drug overdose were eligible and separated into three groups: cocaine (n = 47), other drugs (n = 128), and controls (n = 11). Data were obtained from medical records and linked to waste serum specimens, sent as part of routine clinical care, for biomarker analysis. Serum specimens were collected and analyzed using enzyme-linked immunosorbent assay kit for three biomarkers of endothelial dysfunction: (a) endothelin-1 (ET-1), (b) regulated upon activation normal T cell expressed and secreted (RANTES), and (c) soluble intercellular adhesion molecule-1 (siCAM-1). Mean siCAM was elevated for cocaine compared with controls and other drugs (p < .01); however, mean RANTES and ET-1 levels were not significantly different for any drug exposure groups. Receiver operating characteristics curve analysis for prediction of in-hospital ACVE revealed excellent performance of siCAM-1 (area under curve, 0.86; p < .001) but lack of predictive utility for either RANTES or ET-1. These results suggest that serum siCAM-1 is a viable biomarker for acute cocaine overdose and that endothelial dysfunction may be an important surrogate for adverse cardiovascular events following any drug overdose.
兴奋剂药物过量与不良心血管事件（ACVE）的风险增加有关，其中一些可能归因于内皮功能障碍。本研究的目的是评估急诊（ED）中急性可卡因过量患者内皮功能障碍的生物标志物，并评估 ED 中任何急性药物过量患者住院期间 ACVE 的相关性。这是一项为期 9 个月（2015-2016 年）的前瞻性连续队列研究，在两家城市三级护理医院的 ED 进行。符合条件的连续成年（≥18 岁）患者表现出疑似急性药物过量，并分为三组：可卡因（n = 47）、其他药物（n = 128）和对照组（n = 11）。数据来自病历，并与废物血清标本相关联，这些标本是作为常规临床护理的一部分发送的，用于生物标志物分析。使用酶联免疫吸附测定试剂盒收集和分析血清标本，用于内皮功能障碍的三种生物标志物：（a）内皮素-1（ET-1）、（b）激活正常 T 细胞表达和分泌的调节因子（RANTES）和（c）可溶性细胞间黏附分子-1（siCAM-1）。与对照组和其他药物相比，可卡因的平均 siCAM 升高（p <.01）；然而，任何药物暴露组的 RANTES 和 ET-1 水平均无显着差异。用于预测住院期间 ACVE 的受试者工作特征曲线分析显示 siCAM-1 的出色表现（曲线下面积，0.86；p <.001），但 RANTES 或 ET-1 均缺乏预测能力。这些结果表明，血清 siCAM-1 是急性可卡因过量的可行生物标志物，内皮功能障碍可能是任何药物过量后不良心血管事件的重要替代指标。
