Bogart Joseph, Otteson Todd
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.
Laryngoscope. 2025 Jan;135(1):45-49. doi: 10.1002/lary.31644. Epub 2024 Jul 15.
Individuals with angioedema (AE) are at high risk for airway compromise and often require endotracheal intubation. Patient factors predisposing one to airway compromise are not well described. The objective of this study is to examine whether substance use disorder (SUD) in patients with AE is associated with need for airway intervention.
This population-based retrospective cohort study compared AE patients with SUD versus propensity-matched control groups. Outcomes were hospitalization, intubation, and tracheotomy. Using the TriNetX National Database, this study included 28,931 patients with SUD and 117,509 patients without SUD who presented with AE.
Among patients with AE, those with each subtype of SUD (alcohol, cannabis, cocaine, tobacco, and opioids) were found to have higher risk of severe AE compared to propensity-matched non-SUD cohorts. Rate of hospitalization after cohort matching ranged from 20.4% for tobacco use disorder to 30.4% for cocaine use disorder, all significantly higher than the 8.0% in a population without SUD. Each SUD subtype was associated with a higher rate of intubation compared with matched non-SUD groups, with cannabis use disorder having the highest relative risk (RR) of 3.67 (95% CI: 2.69-5.02). Tobacco (RR = 2.45, 95% CI: 1.79-3.34) and alcohol (RR = 2.82, 95% CI: 1.73-4.58) use disorders were both associated with significantly higher risk of tracheotomy.
These data suggest that patients with SUD, regardless of subtype, and after propensity matching for demographics and comorbidities are at higher risk for adverse outcomes when presenting with AE. This study highlights clinically relevant predictors of airway compromise.
3 Laryngoscope, 135:45-49, 2025.
血管性水肿（AE）患者气道梗阻风险高，常需气管插管。导致气道梗阻的患者因素尚无充分描述。本研究的目的是探讨AE患者的物质使用障碍（SUD）是否与气道干预需求相关。
这项基于人群的回顾性队列研究将患有SUD的AE患者与倾向匹配的对照组进行比较。结局指标为住院、插管和气管切开术。利用TriNetX国家数据库，本研究纳入了28931例患有SUD的患者和117509例未患SUD且出现AE的患者。
在AE患者中，与倾向匹配的非SUD队列相比，每种SUD亚型（酒精、大麻、可卡因、烟草和阿片类药物）的患者发生严重AE的风险更高。队列匹配后的住院率从烟草使用障碍患者的20.4%到可卡因使用障碍患者的30.4%不等，均显著高于无SUD人群的8.0%。与匹配的非SUD组相比，每种SUD亚型的插管率均较高，大麻使用障碍的相对风险（RR）最高，为3.67（95%CI：2.69 - 5.02）。烟草（RR = 2.45，95%CI：1.79 - 3.34）和酒精（RR = 2.82，95%CI：1.73 - 4.58）使用障碍均与气管切开术的显著更高风险相关。
这些数据表明，SUD患者无论亚型如何，在进行人口统计学和合并症倾向匹配后，出现AE时不良结局风险更高。本研究突出了气道梗阻的临床相关预测因素。
3《喉镜》，135:45 - 49，2025年。
