Nguyen Anh P, Binswanger Ingrid A, Narwaney Komal J, Ford Morgan A, McClure David L, Rinehart Deborah J, Lyons Jason A, Glanz Jason M
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
Colorado Permanente Medical Group, Denver, CO, USA.
Prev Med Rep. 2024 Jul 25;46:102832. doi: 10.1016/j.pmedr.2024.102832. eCollection 2024 Oct.
Chronic opioid use can lead to detrimental effects on the immune and various organ systems that put individuals prescribed chronic opioid therapy (COT) for pain and those with an opioid use disorder (OUD) at risk for severe COVID-19 disease. We assessed the association of COT and OUD with COVID-19-related hospitalization and death to inform targeted interventions to improve clinical outcomes in COVID-19 patients who use opioids.
We conducted a retrospective cohort study of adults ages ≥ 18 with laboratory-confirmed SARS-CoV-2 infection in 2020 and 2021 from three US health systems. We used Cox proportional hazards regression to estimate the 30-day risk of COVID-19-related hospitalization and death associated with two opioid exposures (COT and OUD) following an infection.
The study cohort included 53,123 patients with SARS-CoV-2 infection and a mean (SD) age of 45.1 (16.5), of whom 1,059 (2.0 %) were exposed to COT and 269 (0.5 %) had an OUD diagnosis in the year prior to infection. There were 2,270 observed COVID-19-related hospitalizations or deaths (1.6 per 1,000 person-days, 95 % CI 1.5-1.7). In the fully adjusted model, COT was not associated with increased risk (HR 1.19; 95 % CI, 0.98-1.43), while past-year OUD was independently associated with severe COVID-19 disease (HR 1.82; 95 % CI, 1.18-2.80). Past-year OUD remained associated with increased risk in post-hoc analysis with COVID-19-related hospitalization alone as the outcome (HR 2.00; 95 % CI, 1.30-3.08).
Past-year OUD is a potential independent risk factor for severe COVID-19 disease that warrants monitoring to improve the prognosis of patients with COVID-19.
长期使用阿片类药物会对免疫和多个器官系统产生有害影响，使因疼痛接受长期阿片类药物治疗（COT）的个体以及患有阿片类药物使用障碍（OUD）的个体面临患重症 COVID-19 疾病的风险。我们评估了 COT 和 OUD 与 COVID-19 相关住院和死亡之间的关联，以为改善使用阿片类药物的 COVID-19 患者的临床结局的针对性干预措施提供依据。
我们对 2020 年和 2021 年来自美国三个医疗系统的年龄≥18 岁且实验室确诊为 SARS-CoV-2 感染的成年人进行了一项回顾性队列研究。我们使用 Cox 比例风险回归来估计感染后与两种阿片类药物暴露（COT 和 OUD）相关的 COVID-19 相关住院和死亡的 30 天风险。
研究队列包括 53123 例 SARS-CoV-2 感染患者，平均（标准差）年龄为 45.1（16.5）岁，其中 1059 例（2.0%）在感染前一年暴露于 COT，269 例（0.5%）被诊断为 OUD。观察到 2270 例与 COVID-19 相关的住院或死亡（每 1000 人日 1.6 例，95%CI 1.5-1.7）。在完全调整模型中，COT 与风险增加无关（风险比 1.19；95%CI，0.98-1.43），而过去一年的 OUD 与重症 COVID-19 疾病独立相关（风险比 1.82；95%CI，1.18-2.80）。在仅将 COVID-19 相关住院作为结局的事后分析中，过去一年的 OUD 仍与风险增加相关（风险比 2.00；95%CI，1.30-3.08）。
过去一年的 OUD 是重症 COVID-19 疾病的一个潜在独立危险因素，值得进行监测以改善 COVID-19 患者的预后。
