Ghassan Bandak, MD, MBBS
Marshall University
Huntington, West Virginia
Disclosure information not submitted.
Mahmoud Abouzid, MD
Resident
Marshall University, United States
Disclosure information not submitted.
Ahmad Mahdi, MD
Internal Medicine Resident
Marshall University
Huntington, West Virginia
Disclosure information not submitted.
Kanaan Mansoor, MBBS
Cardiology Fellow
Marshall University
Huntington, West Virginia
Disclosure information not submitted.
Ankit Sakhuja, MBBS, FACP, FASN, FCCP
Assistant Professor Of Medicine
WVU Medicine, J.W. Ruby Memorial Hospital, United States
Disclosure information not submitted.
Todd Gress, MD, MPH
Assistant Dean & Director of Clinical Research
Marshall University, United States
Disclosure information not submitted.
Title: Critically Ill Patients With Substance Use Disorder: A Report Of Clinical Features And Outcomes
INTRODUCTION: Substance use disorder (SUD) is a major health care problem. In 2019, 57.2 million people (20.8%) in the United States (US) reported using any illicit substance in previous year. Critically ill patients with SUD represent about 14-25% of total intensive care unit (ICU) admissions in the US. This study provides the demographics of a large population of critically ill patients with SUD and compare their outcomes with non-SUD critically ill patients
Methods: We used the MIMIC-IV database which contains data on hospitalizations from a tertiary academic medical center in Boston, MA, USA. Data were collected on all adult patients admitted to medical, surgical and trauma ICUs from 2008 to 2019. SUD was defined using ICD codes as well as positive drug tests. We collected DRG data to estimate cost of hospitalizations. We used linear regression to assess the effect of SUD on need for mechanical ventilation (MV), time on MV, diagnosis of delirium, hospital length of stay (LOS), hospital mortality, cost of hospitalization and leaving against medical advice
Results: Among 34,280 patients admitted to the ICU, there were 5,317 (15.5%) with SUD. The SUD population was younger (51.0 VS 62.6 yrs,p< 0.001), had less females (32.8% VS 46.8%,p< 0.001), and less comorbidities; mean Charleston Comorbidity Index ( 3.7 VS 5.5,p< 0.001). The SUD population had twice more patients suffering from mental illness (28.5 % VS 58.7,p< 0.001). Alcohol was the most used substance, followed by opiates. Using multivariate regression analysis, we found that patients with SUD are more likely to require MV (OR 1.5 (1.4-1.6),p< 001), had longer time on the ventilator by 3.7 hours (95% CI:1.4 – 6.0), were more likely to develop delirium (OR 3.5 (3.1-3.9,p< 0.001) and had longer hospital LOS by 0.5 days (95% CI 0.1-0.8). Nevertheless, their hospital mortality and cost of hospital stay were not different than non-SUD patients. Interestingly, they were 3.9 times more likely to leave against medical advice (95% CI:3.1 – 4.9,p< 0.001)
Conclusion: Patients with SUD represent a significant portion of ICU patients. They are more likely to be young, male and have concomitant mental illness. Despite having less medical comorbidities, they are more likely to require MV and have longer LOS, however their mortality rates are similar to patients without SUD