Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: a retrospective cohort analysis.

Carolyn M Shover, Peter Yan, Nicholas J Jackson, Russell G Buhr, Jennifer A Fulcher, Donald P Tashkin, Igor Barjaktarevic
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引用次数: 5

Abstract

Background: While cannabis is known to have immunomodulatory properties, the clinical consequences of its use on outcomes in COVID-19 have not been extensively evaluated. We aimed to assess whether cannabis users hospitalized for COVID-19 had improved outcomes compared to non-users.

Methods: We conducted a retrospective analysis of 1831 patients admitted to two medical centers in Southern California with a diagnosis of COVID-19. We evaluated outcomes including NIH COVID-19 Severity Score, need for supplemental oxygen, ICU (intensive care unit) admission, mechanical ventilation, length of hospitalization, and in-hospital death for cannabis users and non-users. Cannabis use was reported in the patient's social history. Propensity matching was used to account for differences in age, body-mass index, sex, race, tobacco smoking history, and comorbidities known to be risk factors for COVID-19 mortality between cannabis users and non-users.

Results: Of 1831 patients admitted with COVID-19, 69 patients reported active cannabis use (4% of the cohort). Active users were younger (44 years vs. 62 years, p < 0.001), less often diabetic (23.2% vs 37.2%, p < 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, p < 0.001) compared to non-users. Notably, active users had lower levels of inflammatory markers upon admission than non-users-CRP (C-reactive protein) (3.7 mg/L vs 7.6 mg/L, p < 0.001), ferritin (282 μg/L vs 622 μg/L, p < 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, p = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, p = 0.001). Based on univariate analysis, cannabis users had significantly better outcomes compared to non-users as reflected in lower NIH scores (5.1 vs 6.0, p < 0.001), shorter hospitalization (4 days vs 6 days, p < 0.001), lower ICU admission rates (12% vs 31%, p < 0.001), and less need for mechanical ventilation (6% vs 17%, p = 0.027). Using propensity matching, differences in overall survival were not statistically significant between cannabis users and non-users, nevertheless ICU admission was 12 percentage points lower (p = 0.018) and intubation rates were 6 percentage points lower (p = 0.017) in cannabis users.

Conclusions: This retrospective cohort study suggests that active cannabis users hospitalized with COVID-19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation. However, our results need to be interpreted with caution given the limitations of a retrospective analysis. Prospective and observational studies will better elucidate the effects cannabis use in COVID-19 patients.

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大麻消费与住院患者COVID-19严重程度较低相关:回顾性队列分析
背景:虽然已知大麻具有免疫调节特性,但其使用对COVID-19结局的临床后果尚未得到广泛评估。我们的目的是评估因COVID-19住院的大麻使用者与非使用者相比是否有改善的结果。方法:我们对南加州两家医疗中心确诊为COVID-19的1831例患者进行了回顾性分析。我们评估的结果包括NIH COVID-19严重程度评分、补充氧气需求、ICU(重症监护病房)入院、机械通气、住院时间以及大麻使用者和非大麻使用者的院内死亡。患者的社会史中有大麻使用记录。倾向匹配用于解释大麻使用者和非使用者之间年龄、体重指数、性别、种族、吸烟史和已知的COVID-19死亡率危险因素的合并症的差异。结果:在入院的1831名COVID-19患者中,69名患者报告了活跃的大麻使用(占队列的4%)。与非使用者相比,活跃使用者更年轻(44岁对62岁,p < 0.001),更少患糖尿病(23.2%对37.2%,p < 0.021),更频繁地吸烟(20.3%对4.1%,p < 0.001)。值得注意的是,活跃使用者入院时的炎症标志物水平低于非使用者- crp (c反应蛋白)(3.7 mg/L vs 7.6 mg/L, p < 0.001),铁蛋白(282 μg/L vs 622 μg/L, p < 0.001), d -二聚体(468 ng/mL vs 1140 ng/mL, p = 0.017)和降钙素原(0.10 ng/mL vs 0.15 ng/mL, p = 0.001)。基于单变量分析,大麻使用者的结果明显优于非使用者,体现在较低的NIH评分(5.1 vs 6.0, p < 0.001)、较短的住院时间(4天vs 6天,p < 0.001)、较低的ICU入院率(12% vs 31%, p < 0.001)和较少的机械通气需求(6% vs 17%, p = 0.027)。使用倾向匹配,大麻使用者和非大麻使用者的总生存率差异无统计学意义,但大麻使用者的ICU住院率低12个百分点(p = 0.018),插管率低6个百分点(p = 0.017)。结论:这项回顾性队列研究表明,与非使用者相比,因COVID-19住院的活跃大麻使用者的临床结果更好,包括ICU住院或机械通气的需求减少。然而,考虑到回顾性分析的局限性,我们的结果需要谨慎解释。前瞻性和观察性研究将更好地阐明大麻使用对COVID-19患者的影响。
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