Paul Reynolds, BCCCP, PharmD
Assistant Professor
University of Colorado Skaggs School of Pharmacy
Denver, CO, United States
Disclosure information not submitted.
Majid Afshar, MD
Assistant Professor
University of Wisconsin, United States
Disclosure information not submitted.
Garth Wright, MPH
Biostatistician
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, United States
Disclosure information not submitted.
Ellen Burnham, MD
Professor
University of Colorado Department of Medicine-Pulmonary Sciences & Critical Care, United States
Disclosure information not submitted.
Title: Substance abuse disorders and mortality associations in critically ill patients with pnuemonia
Introduction: Alcohol use disorders (AUDs) have been previously reported to independently increase risk for mortality in ICU pneumonia. It remains unknown whether other immunoactive substances impact outcomes in patients hospitalized with pneumonia. The purpose of this study is to establish whether AUDs, cannabis use disorders (CUDs), opioid use disorders (OUDs), or polysubstance use disorders (PUDs) affect clinical trajectories in patients admitted to the ICU with pneumonia.
Methods: A retrospective pharmacoepidemiologic study was conducted using the Premier Incorporated Prospective Database. Patients with a primary or secondary diagnosis of pneumonia admitted to the ICU were included. Exclusion criteria were patients with cystic fibrosis, non-pulmonary infections, outside transfer, lung transplantation, prior mechanical ventilation, interstitial lung disease, or non-viral, non-bacterial pneumonias. Patients with substance abuse disorders, intoxications, overdoses, or withdrawals were identified by the presence of International Classification of Diseases (Ninth and Tenth Revisions) admission diagnosis codes. The primary outcome of the study was in-hospital mortality. The secondary outcome was a composite of receipt of mechanical ventilation, new renal replacement therapy, vasopressor use, paralytic use, or death. A mixed-effects logistic regression analysis was performed with random intercepts for hospital sites, which included age and severity of illness using a previously validated, combined Charlson and Elixhauser comorbidity index.
Results: A total of 167,095 patients met inclusion criteria (n=8802 AUDs; 1,194 CUDs; 2,864 OUDs; 1,142 PUDs; 153,093 no misuse). After adjusting for age and severity of illness, AUDs were found to be associated with in-hospital mortality compared to no misuse group (OR 1.35; 95% CI 1.27-1.43), but OUD was associated with decreased odds for in-hospital mortality (OR 0.643; 0.558-0.741). Presence of an AUD (OR 1.23; 95% CI 1.17-1.3), OUD (OR 1.10;95% CI 1.00-1.20) or PUD (OR 1.19; 95% CI 1.03-1.38) were associated with an increase in the odds risk for the composite outcome of escalation of care compared with no misuse group.
Conclusions: Our findings confirmed the previously described association between AUD and hospital mortality; however, mortality was lower among those with OUDs.