Sager Avinaash R, Desai Rupak, Mylavarapu Maneeth, Shastri Dipsa, Devaprasad Nikitha, Thiagarajan Shiva N, Chandramohan Deepak, Agrawal Anshuman, Gada Urmi, Jain Akhil
Internal Medicine, St. Elizabeth's Medical Center, Boston, MA 02135, United States.
Outcomes Research, Independent Researcher, Atlanta, GA 30033, United States.
World J Crit Care Med. 2025 Jun 9;14(2):100844. doi: 10.5492/wjccm.v14.i2.100844.
The burden of cannabis use disorder (CUD) in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.
To address this knowledge gap, especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.
By applying relevant International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to the National Inpatient Sample database between 2016-2020, we identified CUD(+) and CUD(-) arms among adult cancer admissions with severe sepsis. Comparing the two cohorts, we examined baseline demographic characteristics, epidemiological trends, major adverse cardiac and cerebrovascular events, respiratory failure, hospital cost, and length of stay. We used the Pearson d test for categorical variables and the Mann-Whitney test for continuous, non-normally distributed variables. Multivariable regression analysis was used to control for potential confounders. A value ≤ 0.05 was considered for statistical significance.
We identified a total of 743520 cancer patients admitted with severe sepsis, of which 4945 had CUD. Demographically, the CUD(+) cohort was more likely to be younger (median age = 58 69, < 0.001), male (67.9% 57.2%, < 0.001), black (23.7% 14.4%, < 0.001), Medicaid enrollees (35.2% 10.7%, < 0.001), in whom higher rates of substance use and depression were observed. CUD(+) patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities. There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+) and CUD(-) cohorts on multivariable regression analysis. However, the CUD(+) cohort had lower all-cause mortality (adjusted odds ratio = 0.83, 95% confidence interval: 0.7-0.97, < 0.001) and respiratory failure (adjusted odds ratio = 0.8, 95% confidence interval: 0.69-0.92, = 0.002). Both groups had similar median length of stay, though CUD(+) patients were more likely to have higher hospital cost compared to CUD(-) patients (median = 94574 dollars 86615 dollars, < 0.001).
CUD(+) cancer patients with severe sepsis, who tended to be younger, black, males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure. Future research should aim to better elucidate the underlying mechanisms for these observations.
在患有严重脓毒症的癌症患者中，大麻使用障碍（CUD）的负担及其流行情况和随后的心肺结局尚不清楚。
为了填补这一知识空白，特别是鉴于大麻使用模式的上升及其在癌症中新兴的药理学作用。
通过将相关的《国际疾病分类》第九版和第十版临床修订版代码应用于2016 - 2020年的国家住院样本数据库，我们在患有严重脓毒症的成年癌症住院患者中确定了CUD（+）组和CUD（-）组。比较这两个队列，我们检查了基线人口统计学特征、流行病学趋势、主要不良心脏和脑血管事件、呼吸衰竭、住院费用和住院时间。我们对分类变量使用Pearson卡方检验，对连续的、非正态分布的变量使用Mann-Whitney U检验。多变量回归分析用于控制潜在的混杂因素。P值≤0.05被认为具有统计学意义。
我们共确定了743520例患有严重脓毒症的癌症患者，其中4945例患有CUD。在人口统计学方面，CUD（+）队列更可能是年轻人（中位年龄 = 58对69，P < 0.001）、男性（67.9%对57.2%，P < 0.001）、黑人（23.7%对14.4%，P < 0.001）、医疗补助参保者（35.2%对10.7%，P < 0.001），在这些患者中观察到更高的物质使用和抑郁症发生率。CUD（+）患者还表现出更高的慢性肺病患病率，但心血管合并症发生率较低。在多变量回归分析中，CUD（+）组和CUD（-）组之间的主要不良心脏和脑血管事件没有显著差异。然而，CUD（+）队列的全因死亡率较低（调整后的优势比 = 0.83，95%置信区间：0.7 - 0.97，P < 0.001）和呼吸衰竭发生率较低（调整后的优势比 = 0.8，95%置信区间：0.69 - 0.92，P = 0.002）。两组的中位住院时间相似，尽管与CUD（-）患者相比，CUD（+）患者更可能有更高的住院费用（中位值 = 94574美元对86615美元，P < 0.001）。
患有严重脓毒症的CUD（+）癌症患者往往更年轻、是黑人、男性，物质使用和抑郁症发生率较高，但全因住院死亡率和呼吸衰竭的几率却显著较低。未来的研究应旨在更好地阐明这些观察结果的潜在机制。
