Opioid use disorder increases risk for death from sepsis
Opioid use disorder increased the risk for death from sepsis, especially among young and healthy patients, according to findings presented at the Society of Critical Care Medicine’s Critical Care Congress.
“The rate of sepsis is increasing over time. In addition, the country is in the midst of an opioid crisis,” Mohammad Alrawashdeh, PhD, MSN, a post-doctoral research fellow in therapeutics research and infectious disease epidemiology at Harvard Medical School and Harvard Pilgrim Health Care Institute, told Healio Primary Care. “However, there are lack of studies that look at the relationship between these public health issues using large national databases.”
Researchers analyzed electronic health records of 6,715,286 adult hospitalizations at 373 hospitals in the United States between 2009 and 2015. They found that 375,479 had sepsis, 164,891 had opioid use disorder and 11,861 had both conditions.
Alrawashdeh and colleagues reported that the prevalence of opioid use disorder among patients hospitalized with sepsis increased from 3% to 4.2% (P = .001) and sepsis prevalence was higher in hospitalized patients with opioid use disorder than without opioid use disorder (7.2% vs. 5.6%, P < .001).
Patients with sepsis and opioid use disorder, compared with those without opioid use disorder, had lower mortality rates (14.7% vs. 22.7%). However, these patients were also more likely to be:
- younger (mean age, 53 years vs. 67 years);
- white (78.8% vs. 70.7%);
- healthier (mean Elixhauser score, 7.3 vs. 12.6);
- have more endocarditis (3.9% vs. 0.7%), gram-positive (65.4% vs. 46.9%) and fungal (11.5% vs 6.3%) bloodstream infections;
- require more mechanical ventilation (32.6% vs. 24%);
- experience more ICU admissions (61.2% vs. 51.7%);
- spend more time in ICU (mean length of stay, 7.9 days vs. mean length of stay, 7 days); and
- spend more time in the hospital (mean length of stay 14.8 days vs. mean length of stay, 11.8 days).
Each of these findings was statistically significant, according to the researchers.
Alrawashdeh and colleagues also found that patients with opioid use disorder accounted for 2.1% of deaths among all sepsis hospitalizations but 3.3% of healthy (Elixhauser score 5) and 7.1% of young (age < 50 years) sepsis-associated deaths.
These numbers are worth noting, according to Alrawashdeh.
“Clinicians need to be aware that opioid use disorder only contributes to a small fraction of sepsis cases overall, but disproportionately affects younger and otherwise healthier hospitalized patients,” he said. – by Janel Miller
Reference: Alrawashdeh M, et al. Epidemiology, outcomes, and trends of sepsis in patients with opioid use disorders in U.S. hospitals. Presented at: Society of Critical Care Medicine’s Critical Care Congress; Feb. 16-19, 2020; Orlando.
Disclosures: The authors report no relevant financial disclosures.