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Association between Substance Misuse and Outcomes in Critically III Patients with Pneumonia
Paul M Reynolds1,2,3, Majid Afshar4, Garth C Wright1
1University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.
Annals of the American Thoracic Society
|March 31, 2023
Summary
In intensive care unit (ICU) patients with pneumonia, alcohol misuse increased mortality, while opioid misuse decreased it. Other substance misuse showed varied effects on survival outcomes.
Area of Science:
- Critical Care Medicine
- Public Health
- Pharmacology
Background:
- Alcohol misuse is linked to higher mortality in intensive care unit (ICU) patients with pneumonia.
- The impact of other substance misuse on mortality in this population remains unclear.
Purpose of the Study:
- To investigate the association between alcohol, cannabis, opioid, stimulant misuse, or polysubstance misuse and mortality in ICU patients with pneumonia.
- To examine secondary outcomes such as mechanical ventilation, vasopressor, and paralytic use in relation to substance misuse.
Main Methods:
- Retrospective cohort study using the Premier Healthcare Database (2010-2017).
- Included 167,095 ICU patients diagnosed with pneumonia and treated with antibiotics or antivirals.
- Substance misuse identified via ICD codes; multivariable logistic regression adjusted for confounders.
Main Results:
- Alcohol misuse was associated with increased in-hospital mortality (OR 1.12).
- Opioid misuse was associated with decreased in-hospital mortality (OR 0.46).
- Cannabis, stimulant, and polysubstance misuse showed non-significant associations with mortality after adjustment.
Conclusions:
- Subtypes of substance misuse have differential effects on mortality in severe pneumonia ICU patients.
- Findings highlight the complex relationship between substance use disorders and critical illness outcomes.
- Administrative data offer insights but require careful interpretation due to inherent biases.
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