Sanvisens Arantza, Hernández-Rubio Anna, Zuluaga Paola, Fuster Daniel, Papaseit Esther, Galan Sara, Farré Magí, Muga Robert
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain.
Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain.
Front Pharmacol. 2021 Feb 18;12:625610. doi: 10.3389/fphar.2021.625610. eCollection 2021.
Cocaine Use Disorder (CUD) has been associated with multiple complications and premature death. The purpose of the present study was to analyze the relationship between baseline medical comorbidity and long-term medical outcomes (i.e., hospitalization, death) in a cohort of patients primarily admitted for detoxification. In addition, we aimed to analyze cause-specific mortality. longitudinal study in CUD patients admitted for detoxification between 2001 and 2018. Substance use characteristics, laboratory parameters and medical comorbidity by VACS Index were assessed at admission. Follow-up and health-related outcomes were ascertained through visits and e-health records. Kaplan-Meier and Cox regression models were used to analyze survival and predictors of hospitalization and death. 175 patients (77.7% men) were included. Age at admission was 35 years [IQR: 30-41 years], 59.4% of the patients being intranasal users, 33.5% injectors, and 7.1% smokers. Almost 23% of patients had concomitant alcohol use disorder, 39% were cannabis users and 9% opiate users. The median VACS Index score on admission was 10 points [IQR: 0-22]. After 12 years [IQR: 8.6-15 years] of follow-up there were 1,292 (80.7%) ED admissions and 308 (19.3%) hospitalizations. The incidence rate of ED admission and hospitalization was 18.6 × 100 p-y (95% CI: 15.8-21.8 × 100 p-y). Mortality rate was 1.4 × 100 p-y (95% CI: 0.9-2.0 × 100 p-y) and, baseline comorbidity predicted hospitalization and mortality: those with VACS Index >40 were 3.5 times (HR:3.52, 95% CI: 1.19-10.4) more likely to dye with respect to patients with VACS < 20. addiction care warrants optimal stratification of medical comorbidity to improve health outcomes and survival of CUD patients seeking treatment of the disorder.
可卡因使用障碍（CUD）与多种并发症和过早死亡相关。本研究的目的是分析一组主要因戒毒入院的患者的基线合并症与长期医疗结局（即住院、死亡）之间的关系。此外，我们旨在分析特定病因的死亡率。对2001年至2018年间因戒毒入院的CUD患者进行纵向研究。入院时通过VACS指数评估物质使用特征、实验室参数和合并症。通过就诊和电子健康记录确定随访情况和与健康相关的结局。使用Kaplan-Meier和Cox回归模型分析生存情况以及住院和死亡的预测因素。纳入了175名患者（77.7%为男性）。入院时年龄为35岁[四分位间距：30 - 41岁]，59.4%的患者为鼻吸使用者，33.5%为注射使用者，7.1%为吸烟者。近23%的患者伴有酒精使用障碍，39%为大麻使用者，9%为阿片类药物使用者。入院时VACS指数的中位数为10分[四分位间距：0 - 22]。经过12年[四分位间距：8.6 - 15年]的随访，有1292例（80.7%）急诊入院和308例（19.3%）住院。急诊入院和住院的发生率为18.6×100人年（95%置信区间：15.8 - 21.8×100人年）。死亡率为1.4×100人年（95%置信区间：0.9 - 2.0×100人年），基线合并症可预测住院和死亡情况：VACS指数>40的患者相对于VACS<20的患者死亡可能性高3.5倍（风险比：3.52，95%置信区间：1.19 - 10.4）。成瘾护理需要对合并症进行最佳分层，以改善寻求该疾病治疗的CUD患者的健康结局和生存率。
