Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
BMJ Open. 2021 Nov 26;11(11):e056436. doi: 10.1136/bmjopen-2021-056436.
Patients treated with long-term opioid therapy (LTOT) are known to have compromised immune systems and respiratory function, both of which make them particularly susceptible to the SARS-CoV-2 virus. The objective of this study was to assess the risk of developing severe clinical outcomes among COVID-19 non-cancer patients on LTOT, compared with those without LTOT.
A retrospective cohort design using electronic health records in the TriNetX research database.
418 216 adults diagnosed with COVID-19 in January-December 2020 from 51 US healthcare organisations: 9558 in the LTOT and 408 658 in the control cohort. They did not have cancer diagnoses; only a small proportion might have been treated with opioid maintenance for opioid use disorder.
Patient on LTOT had a higher risk ratio (RR) than control patients to visit an emergency department (RR 2.04, 95% CI 1.93 to 2.16) and be hospitalised (RR 2.91, 95% CI 2.69 to 3.15). Once admitted, LTOT patients were more likely to require intensive care (RR 3.65, 95% CI 3.10 to 4.29), mechanical ventilation (RR 3.47, 95% CI 2.89 to 4.15) and vasopressor support (RR 5.28, 95% CI 3.70 to 7.53) and die within 30 days (RR 1.96, 95% CI 1.67 to 2.30). The LTOT group also showed increased risk (RRs from 2.06 to 3.98, all significant to 95% CI) of more-severe infection (eg, cough, dyspnoea, fever, hypoxaemia, thrombocytopaenia and acute respiratory distress syndrome). Statistically significant differences in several laboratory results and other vital signs appeared clinically negligible.
COVID-19 patients on LTOT were at higher risk of increased morbidity, mortality and healthcare utilisation. Interventions to reduce the need for LTOT and to increase compliance with COVID-19 protective measures may improve outcomes and reduce healthcare cost in this population. Prospective studies need to confirm and refine these findings.
接受长期阿片类药物治疗（LTOT）的患者已知其免疫系统和呼吸系统功能受损，这使他们特别容易感染 SARS-CoV-2 病毒。本研究的目的是评估 COVID-19 非癌症 LTOT 患者与无 LTOT 患者相比，出现严重临床结局的风险。
使用 TriNetX 研究数据库中的电子健康记录进行回顾性队列设计。
2020 年 1 月至 12 月期间，来自 51 家美国医疗机构的 418216 名成年 COVID-19 患者：LTOT 组 9558 例，对照组 408658 例。他们没有癌症诊断；只有一小部分可能因阿片类药物使用障碍而接受阿片类药物维持治疗。
LTOT 组患者比对照组患者更有可能就诊急诊（RR 2.04，95%CI 1.93 至 2.16）和住院（RR 2.91，95%CI 2.69 至 3.15）。一旦住院，LTOT 患者更有可能需要重症监护（RR 3.65，95%CI 3.10 至 4.29）、机械通气（RR 3.47，95%CI 2.89 至 4.15）和血管加压支持（RR 5.28，95%CI 3.70 至 7.53），并且在 30 天内死亡（RR 1.96，95%CI 1.67 至 2.30）。LTOT 组也显示出更严重感染（例如咳嗽、呼吸困难、发热、低氧血症、血小板减少和急性呼吸窘迫综合征）的风险增加（RR 从 2.06 到 3.98，均显著至 95%CI）。在几个实验室结果和其他生命体征方面的统计学显著差异在临床上可以忽略不计。
LTOT 的 COVID-19 患者发生发病率、死亡率和医疗保健利用增加的风险更高。减少 LTOT 需求和提高 COVID-19 保护措施依从性的干预措施可能会改善该人群的结局并降低医疗保健成本。需要前瞻性研究来证实和完善这些发现。
