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.
