COVID-19 a significant risk factor for endocarditis in those with substance use disorders
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For those with substance use disorders, COVID-19 is a significant risk factor for endocarditis, researchers reported in Molecular Psychiatry.
“Recent studies have shown that individuals with cocaine or opioid use disorder are at increased risk for COVID-19 infections and severe outcomes,” Nora D. Volkow, MD, of the NIH’s National Institute on Drug Abuse, and colleagues wrote. “Taken together, existing evidence suggests multiple interactions among cocaine and opioid misuse, COVID-19, cardiovascular systems, inflammation and endocarditis.”
Volkow and fellow researchers sought to ascertain whether COVID-19 is associated with increased risk for endocarditis in patients with opioid or stimulant use disorders, and whether the risk rate increased over time.
Their retrospective cohort study was based on a database of electronic health records of 109 million individuals in the U.S. The study population was comprised of 736,502 individuals diagnosed with opioid use disorder (OUD), 379,623 individuals diagnosed with cocaine use disorder (CocaineUD) and 105,817,030 individuals without a diagnosis of either.
For examining the association of COVID-19 with endocarditis among OUD patients, the study population included 49,331 patients with OUD who contracted COVID-19 between January 2020 and April 2022, and 405,959 patients with OUD who had no documented COVID-19 but had medical encounters with health care organizations during the same time period.
For examining the association of COVID-19 with endocarditis among patients with CocaineUD, the study population included 23,687 patients with CocaineUD who contracted COVID-19 between January 2020 and April 2022 and 192,335 patients with CocaineUD who had no documented COVID-19 but had medical encounters with healthcare organizations during the same time period.
Results showed that the incidence rate of endocarditis among patients with OUD or CocaineUD significantly increased from 2011 to 2022 with acceleration during 2021 to 2022. COVID-19 was associated with increased risk of new diagnosis of endocarditis among patients with OUD (HR, 2.23; 95% CI: 1.92–2.60) and with CocaineUD (HR, 2.24; 95% CI: 1.79–2.80).
Clinically diagnosed COVID-19 was associated with higher risk of endocarditis than lab-test confirmed COVID-19 without clinical diagnosis. Hospitalization within 2 weeks following COVID-19 infection was associated with increased risk of new diagnosis of endocarditis. The risk for endocarditis did not differ between patients with and without EHR-recorded vaccination.
Researchers also found that, in patients with OUD or CocaineUD, the 180-day hospitalization risk following endocarditis was 67.5% in patients with COVID-19, compared with 58.7% in matched patients without COVID-19 (HR, 1.21; 95% CI: 1.07–1.35). The 180-day mortality risk following the new diagnosis of endocarditis was 9.2% in patients with COVID-19, compared with 8% in matched patients without COVID-19 (HR, 1.16; 95% CI: 0.83–1.61).
“As the scientific understanding of long COVID develops, we can now include endocarditis as one long-term effect on key organ systems for people who inject drugs,” Rong Xu, PhD, professor of biomedical informatics at Case Western University and co-author of the study, said in a release from the NIH. “It’s critical that we continue to monitor long term, broad impacts of COVID-19 on people who use drugs.”