{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:20:08Z","timestamp":1781792408434,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32HL155020"],"award-info":[{"award-number":["T32HL155020"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA037317"],"award-info":[{"award-number":["R01DA037317"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA048009"],"award-info":[{"award-number":["R01DA048009"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This secondary analysis of prospective data from the Toxicology Investigators Consortium Core Registry analyzed adult acute or acute\u2010on\u2010chronic 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 &lt;\u200920\u2009mEq\/L, and initial QTc \u2265\u2009500\u2009ms), 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 355 patients analyzed, ACVE occurred in 34 (9.6%) patients. Initial serum bicarbonate &lt;\u200920\u2009mEq\/L (adjusted odds ratio [aOR] 4.42, 95% confidence interval [CI] 1.94\u201310.0) and initial QTc \u2265\u2009500\u2009ms (aOR 2.52, 95% CI 1.01\u20136.09) independently predicted ACVE. Exposure circumstances did not predict ACVE. Initial serum lactate &gt;\u20095.2\u2009mmol\/L independently predicted ACVE (aOR 12.2, 95% CI 2.50\u201375.2) and was 90.7% specific with 80.3% negative predictive value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14960","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T05:48:25Z","timestamp":1718171305000},"page":"1130-1138","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predicting adverse cardiovascular events in emergency department patients with bupropion overdose"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1958-9006","authenticated-orcid":false,"given":"Michael D.","family":"Simpson","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Emergency Medicine, Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Campleman","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Brent","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wax","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"},{"name":"University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex F.","family":"Manini","sequence":"additional","affiliation":[{"name":"Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"New York City Health + Hospitals\/Elmhurst  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Toxicology Investigators Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Injury facts.Deaths by age and cause\u2013Data details. 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