S3362 Impact of Cannabis Use on Rate of Colectomy, Endoscopic Intervention and In-Hospital Mortality Amongst Patients With Ulcerative Colitis: A Retrospective National Study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1). Purpose We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder. Methods We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis. Results We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P < 0.01) and had higher co-morbidity (% of >3 Elixhauser comorbidity score 94.1% vs 60.6%; P < 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P < 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P < 0.01]. Conclusion The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

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Association between cannabis use and complications related to ulcerative colitis in hospitalized patients

Medicine ◽

10.1097/md.0000000000016551 ◽

2019 ◽

Vol 98 (32) ◽

pp. e16551 ◽

Cited By ~ 3

Author(s):

Chimezie Mbachi ◽

Bashar Attar ◽

Olamide Oyenubi ◽

Wang Yuchen ◽

Aisien Efesomwan ◽

...

Keyword(s):

Ulcerative Colitis ◽

Hospitalized Patients ◽

Cannabis Use

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Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers with the Risk of Hospitalization and Death in Hypertensive Patients with Coronavirus Disease-19

10.1101/2020.05.17.20104943 ◽

2020 ◽

Cited By ~ 20

Author(s):

Rohan Khera ◽

Callahan Clark ◽

Yuan Lu ◽

Yinglong Guo ◽

Sheng Ren ◽

...

Keyword(s):

Propensity Score ◽

Angiotensin Converting Enzyme ◽

Hospital Mortality ◽

Ace Inhibitors ◽

Lower Risk ◽

Angiotensin Receptor Blockers ◽

National Study ◽

Converting Enzyme ◽

Angiotensin Receptor ◽

Receptor Blockers

Background: Whether angiotensin-converting enzyme (ACE) Inhibitors and angiotensin receptor blockers (ARBs) mitigate or exacerbate SARS-CoV-2 infection remains uncertain. In a national study, we evaluated the association of ACE inhibitors and ARB with coronavirus disease-19 (COVID-19) hospitalization and mortality among individuals with hypertension. Methods: Among Medicare Advantage and commercially insured individuals, we identified 2,263 people with hypertension, receiving ≥1 antihypertensive agents, and who had a positive outpatient SARS-CoV-2 test (outpatient cohort). In a propensity score-matched analysis, we determined the association of ACE inhibitors and ARBs with the risk of hospitalization for COVID-19. In a second study of 7,933 individuals with hypertension who were hospitalized with COVID-19 (inpatient cohort), we tested the association of these medications with in-hospital mortality. We stratified all our assessments by insurance groups. Results: Among individuals in the outpatient and inpatient cohorts, 31.9% and 29.8%, respectively, used ACE inhibitors and 32.3% and 28.1% used ARBs. In the outpatient study, over a median 30.0 (19.0 - 40.0) days after testing positive, 12.7% were hospitalized for COVID-19. In propensity score-matched analyses, neither ACE inhibitors (HR, 0.77 [0.53, 1.13], P = 0.18), nor ARBs (HR, 0.88 [0.61, 1.26], P = 0.48), were significantly associated with risk of hospitalization. In analyses stratified by insurance group, ACE inhibitors, but not ARBs, were associated with a significant lower risk of hospitalization in the Medicare group (HR, 0.61 [0.41, 0.93], P = 0.02), but not the commercially insured group (HR: 2.14 [0.82, 5.60], P = 0.12; P-interaction 0.09). In the inpatient study, 14.2% died, 59.5% survived to discharge, and 26.3% had an ongoing hospitalization. In propensity score-matched analyses, neither use of ACE inhibitor (0.97 [0.81, 1.16]; P = 0.74) nor ARB (1.15 [0.95, 1.38]; P = 0.15) was associated with risk of in-hospital mortality, in total or in the stratified analyses. Conclusions: The use of ACE inhibitors and ARBs was not associated with the risk of hospitalization or mortality among those infected with SARS-CoV-2. However, there was a nearly 40% lower risk of hospitalization with the use of ACE inhibitors in the Medicare population. This finding merits a clinical trial to evaluate the potential role of ACE inhibitors in reducing the risk of hospitalization among older individuals, who are at an elevated risk of adverse outcomes with the infection.

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Characteristics of Marijuana Usage in Sickle Cell Patients: A Nationwide Analysis

Blood ◽

10.1182/blood-2019-131489 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4848-4848

Author(s):

Arya Mariam Roy ◽

Manojna Konda ◽

Akshay Goel ◽

Appalanaidu Sasapu

Keyword(s):

Hospital Mortality ◽

Mood Disorders ◽

Avascular Necrosis ◽

Sickle Cell ◽

Medical Marijuana ◽

Marijuana Use ◽

Cannabis Use ◽

Acute Chest Syndrome ◽

North Central ◽

Splenic Sequestration

Introduction Sickle cell disease (SCD) associated pain is a significant health care issue in the United States which prompts physicians to prescribe opioids to help treat and prevent the recurrent acute painful episodes. Despite nationwide efforts to reduce narcotic pain medication usage, opioids still remain as the mainstay of pain management in SCD. Many SCD patients are using marijuana to help with their pain, anxiety, appetite, mood and sleep as per recent studies. Cannabinoids in marijuana interact with the body's endocannabinoid system which has receptors in almost every major bodily system. The effect of cannabinoids on these receptors reduces the signaling of inflammatory responses and also reduce cytokine production. Very few states have approved SCD as a qualifying condition for medical marijuana. But we are still unsure about the medical benefits of marijuana in SCD patients as there are very limited studies done so far. In our study, we sought to examine the characteristics and complications of marijuana usage in sickle cell patients. Methods The National Inpatient Sample database for the year 2016 was used to identify admissions with a primary diagnosis of SCD and we grouped patients into those who have a diagnosis of cannabis related disorders (CRD) and those who do not have the diagnosis. ICD- 10 codes are used for identifying the SCD patients and also for CRD. Statistical analysis was performed using STATA and univariate and multivariate analysis were performed. The outcomes that are studied included mortality, length and cost of stay, hospital regions and the association of marijuana use with anxiety, mood disorders. We also studied the association of marijuana with the complications of SCD such as sickle cell pain crisis, vaso occlusive crisis, acute chest syndrome, splenic sequestration, avascular necrosis. Results A total of 37,307 admissions with a principal diagnosis of SCD were identified, out of which 4.09% (N= 1526) had cannabis use disorders. The median age of patients with CRD was found to be 31.21 ± 0.3 when compared to 30.67 ± 0.09 in patients without CRD. Even though SCD admissions were more commonly seen in females when compared to males (61.78% vs 38.22%), cannabis use was seen more associated with males (57.97% vs 42.03%). The in-hospital mortality of SCD was less (0.56%) as compared to the mortality rates of other hematological malignancies. The association of cannabis use with in-hospital mortality was found to be not statistically significant. Also, the median length of stay was less in patients with CRD when compared to patients without CRD (4.88 ± 0.2 vs 5.11 ± 0.03) and also likewise cost of stay. Based on the hospital regions in the US, Cannabis use in SCD was seen more prevalent in South region (44%), then Midwest or north-central (26%), northeast (19%), west (10%) and the result was statistically significant (p= 0.003). The association of cannabis use was not found to be statistically significant with acute chest syndrome and splenic sequestration. Cannabis use was, however, found to be associated with the vaso occlusive crisis and avascular necrosis (OR=1.02, p=0.003 and OR= 1.14, 0.022 respectively) even though we cannot say that cannabis use could be a risk factor as there are other confounding factors like coagulopathy, chronic debilitating conditions. Interestingly, SCD patients with CRD have more risk of developing anxiety (OR= 2.32, p=0.000) and also mood disorders (OR= 2.5, p= 0.001) when compared to SCD patients without CRD. The difference persisted after adjusting for age, gender, race, co-morbidities. Conclusion Marijuana use is more seen in the southern and north-central regions in patients with SCD. Marijuana use was not found to be associated with in-hospital mortality in sickle cell patients. SCD patients are using marijuana mainly for alleviating their pain and sometimes for its euphoria effect. Our study showed that it can cause anxiety and mood disorders. The main limitation of our study was the moderate sample size for SCD patients with CRD. The impact and interaction between CRD and SCD complications need to be evaluated separately in a larger study to get accurate values. Large randomized control trials have to be done to assess if SCD qualifies for prescription of medical marijuana as it possesses benefits as well as risks. Disclosures No relevant conflicts of interest to declare.

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Declining in-hospital mortality in vasculitis: A 17-year US national study

10.5152/eurjrheum.2021.20116 ◽

2021 ◽

Vol 8 (4) ◽

pp. 232-234

Author(s):

Jasvinder A. Singh ◽

◽

John D. Cleveland ◽

◽

Keyword(s):

Hospital Mortality ◽

National Study

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Prevalence of Non-Alcoholic Steatohepatitis (NASH) in Individuals With Ulcerative Colitis: A Population-Based National Study

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-00855 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S477

Author(s):

Jamie A. Elchert ◽

Emad Mansoor ◽

Preetika Sinh ◽

Seth Sclair ◽

Stanley Cohen ◽

...

Keyword(s):

Ulcerative Colitis ◽

Population Based ◽

National Study ◽

Alcoholic Steatohepatitis

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Abstract 209: Association Between Cannabis Use and TakoTsubo Cardiomyopathy (TTC): Analysis from the NIS 2012 - 2014

Circulation Research ◽

10.1161/res.121.suppl_1.209 ◽

2017 ◽

Vol 121 (suppl_1) ◽

Author(s):

Samson Alliu ◽

Adeyinka Adejumo ◽

Oluwole Adegbala ◽

Vinod Namana ◽

Pendkar Chetana ◽

...

Keyword(s):

Hospital Mortality ◽

Takotsubo Cardiomyopathy ◽

Apical Ballooning ◽

Left Ventricular ◽

Cannabis Use ◽

Cannabis User ◽

Ventricular Wall ◽

Significant Difference ◽

Study Population ◽

Logistic Regressions

Background and Objective: Marijuana use causes catecholamine surge with consequent tachycardia and elevation of both systolic and diastolic blood pressure. It is unclear if the catecholamine surge associated is sufficient to cause left ventricular wall apical ballooning (TakoTsubo Cardiomyopathy (TTC)). Given the similarity in the pathophysiology of TTC and mechanism of action of cannabis, we sought to investigate if there is any association. Methods: We obtained data from the HCUP-NIS of all patients older than 45 years hospitalized between 2012 - 2014. Our main outcome was diagnosis of TTC, and main exposure variables was cannabis use both identified using the ICD-9 codes. Using the SURVEYLOGISTICS procedure, we performed logistic regressions to estimate the odds of TTC diagnosis and in-hospital mortality among cannabis users adjusting for demographics, comorbidities, and other recreational drugs. Results: Of the 7,805,400 hospitalized patients who were > 45 years, 10,160 (0.1%) had a diagnosis of TTC, 54,311 (0.7%) were nondependent cannabis user and 5,045 (0.1%) were dependent cannabis users. We observed a significant association between TTC and nondependent cannabis use (OR 1.35, 95% CI: 1.10-1.65), but the association was nonsignificant for dependent cannabis use. After adjusting for potential confounders such as age, race, gender, comorbidities, cocaine, amphetamine and alcohol, nondependent cannabis use was associated with a 2-fold increased odds of TTC (AOR 2.00, 95% CI: 1.61-2.40). However, the association remained nonsignificant for dependent cannabis users (AOR 0.70, 95% CI: 0.25-1.92). Also, among patients diagnosed with TTC, there was no significant difference in the odds of in-hospital mortality among cannabis users (dependent and nondependent) when compared to nonusers (AOR 1.04, 95% CI: 0.39 - 2.70). Conclusion: In our study population, nondependent cannabis use was associated with significantly increased odds of TTC. However, among patients with TTC, in-hospital mortality rate was the same irrespective of cannabis exposure.

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