Shover Carolyn M, Yan Peter, Jackson Nicholas J, Buhr Russell G, Fulcher Jennifer A, Tashkin Donald P, Barjaktarevic Igor
Division of Pulmonary & Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
Offsite Medical Care, Intensive Care Telemedicine, Santa Rosa, CA, USA.
J Cannabis Res. 2022 Aug 5;4(1):46. doi: 10.1186/s42238-022-00152-x.
While cannabis is known to have immunomodulatory properties, the clinical consequences of its use on outcomes in COVID-19 have not been extensively evaluated. We aimed to assess whether cannabis users hospitalized for COVID-19 had improved outcomes compared to non-users.
We conducted a retrospective analysis of 1831 patients admitted to two medical centers in Southern California with a diagnosis of COVID-19. We evaluated outcomes including NIH COVID-19 Severity Score, need for supplemental oxygen, ICU (intensive care unit) admission, mechanical ventilation, length of hospitalization, and in-hospital death for cannabis users and non-users. Cannabis use was reported in the patient's social history. Propensity matching was used to account for differences in age, body-mass index, sex, race, tobacco smoking history, and comorbidities known to be risk factors for COVID-19 mortality between cannabis users and non-users.
Of 1831 patients admitted with COVID-19, 69 patients reported active cannabis use (4% of the cohort). Active users were younger (44 years vs. 62 years, p < 0.001), less often diabetic (23.2% vs 37.2%, p < 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, p < 0.001) compared to non-users. Notably, active users had lower levels of inflammatory markers upon admission than non-users-CRP (C-reactive protein) (3.7 mg/L vs 7.6 mg/L, p < 0.001), ferritin (282 μg/L vs 622 μg/L, p < 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, p = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, p = 0.001). Based on univariate analysis, cannabis users had significantly better outcomes compared to non-users as reflected in lower NIH scores (5.1 vs 6.0, p < 0.001), shorter hospitalization (4 days vs 6 days, p < 0.001), lower ICU admission rates (12% vs 31%, p < 0.001), and less need for mechanical ventilation (6% vs 17%, p = 0.027). Using propensity matching, differences in overall survival were not statistically significant between cannabis users and non-users, nevertheless ICU admission was 12 percentage points lower (p = 0.018) and intubation rates were 6 percentage points lower (p = 0.017) in cannabis users.
This retrospective cohort study suggests that active cannabis users hospitalized with COVID-19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation. However, our results need to be interpreted with caution given the limitations of a retrospective analysis. Prospective and observational studies will better elucidate the effects cannabis use in COVID-19 patients.
虽然已知大麻具有免疫调节特性，但其使用对新冠病毒病（COVID-19）结局的临床影响尚未得到广泛评估。我们旨在评估因COVID-19住院的大麻使用者与非使用者相比是否有更好的结局。
我们对加利福尼亚州南部两个医疗中心收治的1831例诊断为COVID-19的患者进行了回顾性分析。我们评估了结局，包括美国国立卫生研究院（NIH）COVID-19严重程度评分、是否需要补充氧气、入住重症监护病房（ICU）、机械通气、住院时间以及大麻使用者和非使用者的院内死亡情况。患者的社会史中报告了大麻使用情况。倾向匹配用于解释大麻使用者和非使用者之间在年龄、体重指数、性别、种族、吸烟史以及已知为COVID-19死亡风险因素的合并症方面的差异。
在1831例因COVID-19入院的患者中，69例报告有近期大麻使用史（占队列的4%）。与非使用者相比，近期使用者更年轻（44岁对62岁，p<0.001），糖尿病患者较少（23.2%对37.2%，p<0.021），且当前吸烟者更频繁（20.3%对4.1%，p<0.001）。值得注意的是，近期使用者入院时炎症标志物水平低于非使用者——C反应蛋白（CRP）（3.7mg/L对7.6mg/L，p<0.001）、铁蛋白（282μg/L对622μg/L，p<0.001）、D-二聚体（468ng/mL对1140ng/mL，p = 0.017）和降钙素原（0.10ng/mL对0.15ng/mL，p = 0.001）。基于单因素分析，大麻使用者与非使用者相比结局明显更好，表现为NIH评分更低（5.1对6.0，p<0.001）、住院时间更短（4天对6天，p<0.001）、ICU入住率更低（12%对31%，p<0.001）以及机械通气需求更少（6%对17%，p = 0.027）。使用倾向匹配后，大麻使用者和非使用者之间的总体生存率差异无统计学意义，不过大麻使用者的ICU入住率低12个百分点（p = 0.018），插管率低6个百分点（p = 0.017）。
这项回顾性队列研究表明，因COVID-19住院的近期大麻使用者与非使用者相比有更好的临床结局，包括入住ICU或机械通气需求减少。然而，鉴于回顾性分析的局限性，我们的结果需要谨慎解释。前瞻性和观察性研究将更好地阐明大麻使用对COVID-19患者的影响。
