PMID- 36496114
OWN - NLM
STAT- MEDLINE
DCOM- 20230320
LR  - 20230403
IS  - 1873-6513 (Electronic)
IS  - 0885-3924 (Linking)
VI  - 65
IP  - 4
DP  - 2023 Apr
TI  - Hospital Opioid Usage and Adverse Events in Patients With End-Stage Liver 
      Disease.
PG  - 326-334.e2
LID - S0885-3924(22)01002-8 [pii]
LID - 10.1016/j.jpainsymman.2022.11.026 [doi]
AB  - CONTEXT: Patients with end-stage liver disease (ESLD) commonly experience pain 
      and other symptoms that result in a poor quality of life. Few studies have 
      examined opioid usage, adverse events (AEs), and other outcomes in ESLD patients 
      receiving opioid analgesia. OBJECTIVES: This study aimed to compare outcomes in 
      ESLD patients who received opioids to those who did not and to determine risk 
      factors for AEs. METHODS: This was a retrospective case-cohort study of 270 
      hospitalized patients with ESLD that used administrative and clinical data from 
      the electronic medical record. RESULTS: Two-thirds of patients with ESLD admitted 
      during the study period received at least one opioid analgesic. Patients who 
      received opioids presented with a greater number of liver related complications 
      and higher rates of anxiety (32% vs. 17%, P= 0.007), had substantially worse 
      initial and average pain scores (both P< 0.001), and received more palliative 
      care consultations. The opioid group had somewhat more respiratory (22.2% vs. 
      11.1%, P= 0.02) and gastrointestinal (38.5% vs. 25.2%, P= 0.03) AEs, but no 
      increase in CNS adverse events which included hepatic encephalopathy. Anxiety and 
      disease severity (i.e., the number of liver related complications) but not opioid 
      administration were risk factors for the number of AEs. CONCLUSION: Opioid 
      administration was not an independent risk factor for the number of AEs in 
      hospitalized patients with ESLD, whereas anxiety and more liver-related 
      complications increased AE risk. Our findings suggest that opioids have an 
      appropriate and reasonably safe role in alleviation of pain in patients with 
      ESLD.
CI  - Copyright (c) 2022 American Academy of Hospice and Palliative Medicine. Published 
      by Elsevier Inc. All rights reserved.
FAU - Johnson, Amy W
AU  - Johnson AW
AD  - Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), 
      Indianapolis. Electronic address: aj94@iu.edu.
FAU - Golzarri Arroyo, Lilian
AU  - Golzarri Arroyo L
AD  - Department of Epidemiology and Biostatistics (L.G-A), School of Public Health, 
      Bloomington.
FAU - Mahendraker, Neetu
AU  - Mahendraker N
AD  - Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), 
      Indianapolis.
FAU - Hosty, Jack
AU  - Hosty J
AD  - Indiana University School of Medicine (J.H.), Indianapolis.
FAU - Kroenke, Kurt
AU  - Kroenke K
AD  - Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), 
      Indianapolis; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indianapolis USA.
LA  - eng
GR  - UL1 TR001108/TR/NCATS NIH HHS/United States
GR  - KL2 TR001106/TR/NCATS NIH HHS/United States
GR  - TL1 TR001107/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20221208
PL  - United States
TA  - J Pain Symptom Manage
JT  - Journal of pain and symptom management
JID - 8605836
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Humans
MH  - *Analgesics, Opioid/adverse effects
MH  - Cohort Studies
MH  - Retrospective Studies
MH  - *End Stage Liver Disease
MH  - Quality of Life
MH  - Pain/drug therapy
MH  - Hospitals
OTO - NOTNLM
OT  - Cirrhosis,opioids
OT  - adverse events
OT  - analgesia
OT  - palliative care anxiety
COIS- Disclosure This work was funded by the "Advanced Scholarship Program for 
      Internists in Research and Education," Indiana University School of Medicine, 
      Indianapolis, IN, USA. Study data were collected and managed using REDCap 
      electronic data capture tools hosted at the Indiana Clinical and Translational 
      Sciences Institute (Indiana CTSI) funded, in part by Grant Numbers UL1TR001108, 
      KL2TR001106, or TL1TR001107 from the National Institutes of Health, National 
      Center for Advancing Translational Sciences, Clinical and Translational Sciences 
      Award and at the Indiana University Pervasive Technology Institute 
      (https://pti.iu.edu/) which supports REDCap with IT infrastructure and consulting 
      resources. All authors deny any conflicts of interest.
EDAT- 2022/12/11 06:00
MHDA- 2023/03/21 06:00
CRDT- 2022/12/10 19:25
PHST- 2022/08/16 00:00 [received]
PHST- 2022/11/21 00:00 [revised]
PHST- 2022/11/26 00:00 [accepted]
PHST- 2022/12/11 06:00 [pubmed]
PHST- 2023/03/21 06:00 [medline]
PHST- 2022/12/10 19:25 [entrez]
AID - S0885-3924(22)01002-8 [pii]
AID - 10.1016/j.jpainsymman.2022.11.026 [doi]
PST - ppublish
SO  - J Pain Symptom Manage. 2023 Apr;65(4):326-334.e2. doi: 
      10.1016/j.jpainsymman.2022.11.026. Epub 2022 Dec 8.