Cannabis use lowers odds for mortality, respiratory failure in COVID-19 hospitalization
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Key takeaways:
- Use of cannabis positively impacted two hospitalization outcomes.
- Other outcomes, such as hospitalization duration and intubation rate, were similar in the use vs. no use groups.
BOSTON — During COVID-19 hospitalization, patients faced lower odds for mortality and respiratory failure with vs. without documented cannabis use, according to data presented at the CHEST Annual Meeting.
“More work is needed before our findings can be generalized to cover everyday practice,” Donclair Brown, BMedSci, MBBS, chief medical resident at NYC Health and Hospitals/Jacobi Medical Center/North Central Bronx, told Healio. “It however does lead me to believe that as use of medicinal cannabinoids increases, there may be some role for these products in COVID infections.
“This could be an exciting area of study because if these findings can be confirmed then reproduced in a prospective manner, the applications could be far reaching,” Brown added. “Could there be a role for cannabinoids in other respiratory conditions? Could there be a role in systemic inflammation? This could be the springboard for the development of new therapies.”
Using the HCUP-NIS database, Brown and colleagues assessed 1,050,720 patients hospitalized for COVID-19 in 2020 to find out how cannabis use impacted mortality, respiratory failure, hospitalization duration, total hospital charges, intubation rate and use of extracorporeal membrane oxygenation (ECMO).
Researchers found documented cannabis use in 5,145 patients, whereas the rest had no documented use.
Four baseline characteristics differed between the two sets of patients, as the cannabis use group was made up of more younger, male and non-white individuals who had a lower comorbidity burden, according to the abstract.
When compared with those who did not use cannabis, those who did use cannabis had significantly decreased odds for in-hospital mortality (adjusted OR = 0.57; 95% CI, 0.37-0.87) in a hospital-level confounder-adjusted multivariate regression model.
“The mortality benefit that we found was definitely surprising,” Brown told Healio. “We had actually expected worse outcomes in the group with cannabis use.”
Patients with vs. without documented cannabis use also had a significant reduced likelihood for respiratory failure (aOR = 0.5; 95% CI, 0.45-0.58), according to researchers.
In contrast, researchers reported that those with cannabis use and those without cannabis use had similar hospitalization durations, total hospital charges, intubation rates and use of ECMO. According to the abstract, these counterintuitive results may be due to cannabis’ ability to lower proinflammatory markers.
“Future studies can further solidify the presence of our observed benefit in a randomized controlled setting,” Brown told Healio. “We also have the opportunity to investigate if the delivery mechanism of cannabinoids affects the outcome. Is it that persons get maximal benefit through inhalation, or is it a systemic effect which persists regardless of the specific mode of ingestion?”
For more information:
Donclair Brown, BMedSci, MBBS, can be reached at brownd74@nychhc.org or donclair.brown@gmail.com.
Perspective
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At the CHEST Annual Meeting in Boston, Brown and colleagues presented their findings comparing clinical outcomes in patients admitted to the hospital with a primary diagnosis of COVID-19 with and without cannabis use. After adjustment for hospital-level confounders, patients with COVID-19 who used cannabis had lower rates of in-hospital mortality rate and respiratory failure compared with non-cannabis users. Other outcomes, including length of stay, total hospital charge, rate of intubation and ECMO use, were not different between groups. The authors suggest that cannabis use may have a protective effect against severe COVID-19 infection and highlight the need for future prospective and translational studies of cannabis use in COVID-19.
Previous studies of cannabis use in COVID-19 have shown conflicting results, with increased or decreased risk for adverse outcomes depending on the cohort that was studied. We note that the authors performed an analysis of the 2020 Nationwide Inpatient Sample, which is a robust administrative database representing 20% of all hospitalizations in the United States. While their use of a large database is a strength of the study, there are several caveats to consider when interpreting their analyses.
For one, the authors note that cannabis users were younger, male, non-white and had a lower comorbidity score. While the authors state that they adjusted for hospital-level confounders (ie, hospital size, type or geographic location), it is unclear whether the authors adjusted for patient-level characteristics. Previous studies have noted a strong association between patient characteristics (including age, sex and comorbidities) and the risk for adverse outcomes due to COVID-19.
Given that the cannabis users with COVID-19 were younger and less likely to have comorbidities, there is the potential for confounding bias in this type of analysis, where confounders are associated with both the exposure (ie, cannabis use) and the outcome (ie, mortality). Analyses that adjust for patient demographics and comorbidities, such as regression models or propensity-score matching, may further strengthen the authors’ hypothesis that cannabis use has a protective effect against COVID-19.
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