E0474 - Effect of Cannabis on Mortality and Resource Utilisation in Patients With Acute on Chronic Liver Failure: Nationwide Analysis

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Aalam Sohal, MD

UCSF Fresno
Fresno, CA

Aalam Sohal, MD¹, Hunza Chaudhry, MD², Armaan Dhaliwal, MBBS³, Raghav Sharma, MBBS⁴, Piyush Singla, MBBS⁵, Sohail Sodhi, MD⁶, Gagan Gupta, MBBS⁷, Dino Dukovic, ⁸, Kris Kowdley, MD, FACG⁹
¹UCSF Fresno, Fresno, CA; ²UCSF-Fresno, Fresno, CA; ³University of Arizona, Tucson, AZ; ⁴Punjab Instute of Medical Sciences, Jalandhar, Jalandhar, Punjab, India; ⁵Dayanand Medical College and Hospital, Ludhiana, Punjab, India; ⁶Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ; ⁷Dayanand Medical College and Hospital, Phillaur, Punjab, India; ⁸Ross University School of Medicine, Anaheim, CA; ⁹Liver Institute North West, Seattle, WA

Introduction: Prior literature suggests that cannabis use may be associated with decreased progression of liver fibrosis in chronic liver disease patients. The effect of cannabis use on hospital outcomes in patients with acute on chronic liver failure (ACLF) has not been previously studied.

Methods: We queried the National Inpatient Sample (NIS) database using ICD-10 codes. Acute on chronic liver failure (ACLF) was defined as the presence of renal failure or hepatic encephalopathy and one other organ dysfunction or two non-renal organ failures in patients with cirrhosis and a decompensating event. Decompensating events were defined as presence of ascites, varices, hepatic encephalopathy, or infection. The relationship between cannabis use and mortality, length of stay, total hospitalization cost, and charge was examined using multivariate analysis

Results: A total of 1.78 million adult patients were admitted with acute decompensation of cirrhosis between 2016 and 2019. Of these, 830,365 patients (46.4%) met criteria for ACLF and 16,895 patients (2.04%) were reported to have cannabis use. Patients with cannabis use were younger (mean age 51.9 vs 61.3), and more likely to be male (70.7% vs 58.3%, p< 0.001) as compared to the patients without cannabis use. Patients who consumed cannabis were also more likely to have alcohol-related liver disease (66.5% vs 46.91%, p< 0.001) and hepatitis C (19.2% vs 10.5%, p< 0.001). The demographics of the patient population are presented in Table 1. Cannabis use was associated with a 24.1 % lower mortality risk on multivariate analysis (aOR-0.759, 95 % CI-0.68-0.85, p< 0.001) after adjusting for patient demographics, hospital characteristics and acute decompensations. Cannabis use was not associated with length of stay (p=0.09), but was associated with lower hospital charges and cost (-$10,820, p< 0.001 and -$2,180, p< 0.001, respectively) compared to patients without cannabis use.

Discussion: Cannabis use is independently associated with decreased mortality risk in hospitalized patients with ACLF. Further research is necessary to understand the effect of cannabis use on hospital outcomes in patients with ACLF.

Demographics	No Cannabis Use n (%)	Cannabis Use n (%)	p-value
Age Category			< 0.001
18-44	71,170 (8.75)	4,230 (25.04)
45-64	420,960 (51.75)	10,835 (64.13)
>65	321,340 (39.50)	1,830 (10.83)
Sex			< 0.001
Males	480,475 (59.06)	12,375 (73.25)
Females	332,995 (40.94)	4,520 (26.75)
Race			< 0.001
White	537,885 (66.12)	10,815 (64.01)
Black	81,695 (10.04)	2,495 (14.77)
Hispanic	137,980 (16.96)	2,485 (14.71)
Asian/Pacific Islander	18,230 (02.24)	155 (0.92)
Primary Insurance			< 0.001
Medicare	401,630 (49.37)	4,825 (28.56)
Medicaid	191,725 (23.57)	7,535 (44.60)
Private	157,775 (19.39)	2,600 (15.39)
Uninsured	36,800 (4.52)	1,295 (7.67)
Median Household Income			< 0.001
Lowest quartile	273,700 (33.65)	6,500 (38.47)
Second quartile	215,015 (26.43)	4,670 (27.64)
Third quartile	187,925 (23.10)	3,585 (21.22)
Highest quartile	136,830 (16.82)	2,140 (12.67)
Hospital Location			< 0.001
Rural	47,335 (5.82)	800 (4.74)
Urban	766,135 (94.18)	16,095 (95.26)
Hospital Teaching Status			< 0.001
Non-teaching hospitals	215,155 (26.45)	3,770 (22.31)
Teaching hospitals	598,315 (73.55)	13,125 (77.69)
Elixhauser Comorbidities			< 0.001
0-1	845 (0.1)	0 (0)
2-3	50040 (6.15)	265 (1.57)
4 or more	762,585 (93.74)	16,630 (98.43)
Etiology
Alcoholic Liver Disease	389,545 (47.89)	11,710 (69.31)	< 0.001
Hepatitis C	79,870 (9.82)	3,030 (17.93)	< 0.001
Decompensations
Hepatic Encephalopathy	451,700 (55.53)	9,885 (58.51)	0.0005
Ascites	500,290 (61.5)	10,635 (62.95)	0.0934
Varices	55,435 (6.82)	1,500 (8.88)	< 0.001
Bacterial Infection	346,430 (42.59)	6,285 (37.2)	< 0.001

Table: Patient demographics, hospital characteristics and decompensations of patients admitted with ACLF stratified by cannabis use.

Disclosures:

Aalam Sohal indicated no relevant financial relationships.

Hunza Chaudhry indicated no relevant financial relationships.

Armaan Dhaliwal indicated no relevant financial relationships.

Raghav Sharma indicated no relevant financial relationships.

Piyush Singla indicated no relevant financial relationships.

Sohail Sodhi indicated no relevant financial relationships.

Gagan Gupta indicated no relevant financial relationships.

Dino Dukovic indicated no relevant financial relationships.

Kris Kowdley: abbvie – Speakers Bureau. CymaBay – Advisor or Review Panel Member, Grant/Research Support. Genfit – Advisor or Review Panel Member, Grant/Research Support. Intercept – Advisor or Review Panel Member, Consultant, Independent Contractor. Madrigal – Advisor or Review Panel Member, Grant/Research Support. Mallinckrodt – Advisor or Review Panel Member. NGM – Grant/Research Support.

Aalam Sohal, MD¹, Hunza Chaudhry, MD², Armaan Dhaliwal, MBBS³, Raghav Sharma, MBBS⁴, Piyush Singla, MBBS⁵, Sohail Sodhi, MD⁶, Gagan Gupta, MBBS⁷, Dino Dukovic, ⁸, Kris Kowdley, MD, FACG⁹. E0474 - Effect of Cannabis on Mortality and Resource Utilisation in Patients With Acute on Chronic Liver Failure: Nationwide Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.