Heightened mortality risk after a non-fatal opioid overdose: Risk factors for mortality in the week following emergency treatment

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-08-26 DOI:10.1111/add.16632

Desiree Eide, Linn Gjersing, Aksel Wüsthoff Danielsen, Arne Kristian Skulberg, Ola Dale, Anne-Catherine Braarud, Fridtjof Heyerdahl, Ida Tylleskar

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引用次数: 0

Abstract

Aims

To measure all-cause mortality risk after an ambulance-attended non-fatal opioid overdose and associations with number of days following attendance, and individual and clinical characteristics.

Design

A prospective observational study.

Setting

Oslo, Norway.

Participants

Patients treated with naloxone for opioid overdose by Oslo Emergency Services between 1 June 2014 and 31 December 2018.

Measurements

Medical records were linked to the national Cause of Death Registry (1 June 2014–31 December 2019). Crude mortality rates (CMR) and incidence risk ratios (IRR) with 95% confidence intervals (CI) were estimated for the time periods (0–7 days, 8–31 days, 32–91 days, 92–183 days, >183 days) using multivariate Poisson regression analysis. IRR were estimated for sex, age, Glasgow Coma Scale (GCS), respiration rate, place of attendance and non-transportation following treatment. Robust variance estimates applied due to multiple risk periods. Standardized Mortality Rates (SMR) were estimated.

Findings

Overall, 890 patients treated for 1764 overdoses contributed to a total time at risk of 3142 person-years (PY). Median number of attendances was 1 (range 1–27). The majority were male (75.5%) and the mean age was 37.7 years. In total, 112 (12.6%) died; 5.2% within 183 days and 2.2% between 184 and 365 days. Acute poisoning was the most common single cause of death (52.7%). The CMR was 3.6 (95% CI = 3.0–4.2) per 100-PY. The women had a SMR of 32 (95% CI = 15.8–57.9) and the men 24.9 (95% CI = 17.7–34.2). The CMR (22.2, 95% CI = 10.6–46.8) was particularly high in the first 7 days, and significantly higher than in the following periods. However, this finding was only valid for those with severe overdose symptoms (GCS score = 3/15 and/or respiratory rate ≤6/min). Except for increasing age, no other indicators were associated with the mortality risk.

Conclusion

Patients treated by Oslo Emergency Services between June 2014 and December 2018 for a non-fatal opioid overdose with severe overdose symptoms at attendance had an overall high mortality risk compared with the general population, but particularly during the first 7 days after attendance.

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非致命性阿片类药物过量后的死亡风险增加：紧急治疗后一周内的死亡风险因素。

目的：测量救护车救治非致命性阿片类药物过量后的全因死亡风险，以及与救治后天数、个人和临床特征的关系：设计：前瞻性观察研究：地点：挪威奥斯陆：2014年6月1日至2018年12月31日期间在奥斯陆急救中心接受纳洛酮治疗的阿片类药物过量患者：医疗记录与全国死因登记（2014 年 6 月 1 日至 2019 年 12 月 31 日）相链接。使用多变量泊松回归分析估算了各时间段（0-7 天、8-31 天、32-91 天、92-183 天、>183 天）的粗死亡率（CMR）和发病风险比（IRR）及 95% 置信区间（CI）。对性别、年龄、格拉斯哥昏迷量表（GCS）、呼吸频率、就诊地点和治疗后未转运等因素进行了 IRR 估计。由于存在多个风险期，因此采用了稳健的方差估计。对标准化死亡率（SMR）进行了估算：总体而言，共有 890 名患者因 1764 次用药过量接受了治疗，总风险时间为 3142 人年（PY）。就诊次数中位数为 1 次（1-27 次不等）。大多数患者为男性（75.5%），平均年龄为 37.7 岁。共有 112 人（12.6%）死亡，其中 5.2% 死于 183 天内，2.2% 死于 184 天至 365 天之间。急性中毒是最常见的单一死因（52.7%）。CMR为3.6（95% CI = 3.0-4.2）/100-PY。女性的 SMR 为 32（95% CI = 15.8-57.9），男性为 24.9（95% CI = 17.7-34.2）。头 7 天的 CMR（22.2，95% CI = 10.6-46.8）尤其高，明显高于随后的时间段。然而，这一结果仅适用于出现严重用药过量症状的患者（GCS 评分 = 3/15，和/或呼吸频率≤6/分钟）。除年龄增长外，其他指标均与死亡风险无关：2014年6月至2018年12月期间，在奥斯陆急救中心接受治疗的非致命性阿片类药物过量患者在就诊时出现严重过量症状，与普通人群相比，其总体死亡风险较高，尤其是在就诊后的前7天。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.