Epidemiology, Outcomes, and Trends of Patients With Sepsis and Opioid-Related Hospitalizations in U.S. Hospitals*

Abstract

OBJECTIVES: Widespread use and misuse of prescription and illicit opioids have exposed millions to health risks including serious infectious complications. Little is known, however, about the association between opioid use and sepsis. DESIGN: Retrospective cohort study. SETTING: About 373 U.S. hospitals. Patients: Adults hospitalized between January 2009 and September 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sepsis was identified by clinical indicators of concurrent infection and organ dysfunction. Opioid-related hospitalizations were identified by the International Classification of Diseases, 9th Revision, Clinical Modification codes and/or inpatient orders for buprenorphine. Clinical characteristics and outcomes were compared by sepsis and opioid-related hospitalization status. The association between opioid-related hospitalization and all-cause, in-hospital mortality in patients with sepsis was assessed using mixed-effects logistic models to adjust for baseline characteristics and severity of illness. The cohort included 6,715,286 hospitalizations; 375,479 (5.6%) had sepsis, 130,399 (1.9%) had opioid-related hospitalizations, and 8,764 (0.1%) had both. Compared with sepsis patients without opioid-related hospitalizations (n = 366,715), sepsis patients with opioid-related hospitalizations (n = 8,764) were younger (mean 52.3 vs 66.9 yr) and healthier (mean Elixhauser score 5.4 vs 10.5), had more bloodstream infections from Gram-positive and fungal pathogens (68.9% vs 47.0% and 10.6% vs 6.4%, respectively), and had lower in-hospital mortality rates (10.6% vs 16.2%; adjusted odds ratio, 0.73; 95% CI, 0.60–0.79; p < 0.001 for all comparisons). Of 1,803 patients with opioid-related hospitalizations who died in-hospital, 928 (51.5%) had sepsis. Opioid-related hospitalizations accounted for 1.5% of all sepsis-associated deaths, including 5.7% of sepsis deaths among patients less than 50 years old. From 2009 to 2015, the proportion of sepsis hospitalizations that were opioid-related increased by 77% (95% CI, 40.7–123.5%). CONCLUSIONS: Sepsis is an important cause of morbidity and mortality in patients with opioid-related hospitalizations, and opioid-related hospitalizations contribute disproportionately to sepsis-associated deaths among younger patients. In addition to ongoing efforts to combat the opioid crisis, public health agencies should focus on raising awareness about sepsis among patients who use opioids and their providers.

COVID‐19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems

“…Hepatitis‐C was also associated with lower risk of sepsis and mortality. This is important, given the relatively high prevalence of both hepatitis‐C and sepsis among patients with OUD, often linked to injection drug use [ 16 ]. Research is mixed on the relationship between hepatitis‐C and COVID‐19, with some studies associating hepatitis‐C with higher mortality [ 35 , 51 ], others finding no effect [ 52 ] and others reporting a protective effect [ 53 ].…”

“…Prior studies have not examined specific complications of COVID‐19 to which people with OUD may be particularly vulnerable (e.g. kidney failure and sepsis) [ 15 , 16 ]. Moreover, no studies to our knowledge have identified particular characteristics among OUD patients associated with increased risk for COVID‐19 progression and death.…”

Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews

“…In addition, the literature suggests that the prevention of sepsis plays an important role in the care of all types of opioid users. In a US cohort based in 373 hospitals, almost half of the mortality outcomes were associated with sepsis diagnosis ( 50 ). The proportion of sepsis hospitalizations related to opioid use in this cohort increased by 77% between 2009 and 2015.…”

Initiation of medication for opioid use disorder across a health system: A retrospective analysis of patient characteristics and inpatient outcomes

“…While more work is needed to characterize the mechanism behind the length of stay changes, our analysis and existing scholarship both suggest that systematic MOUD may also facilitate treatment adherence, leading again to better care for the OUD population. This is particularly important in context of infections stemming from intravenous drug use such as sepsis that require extensive courses of antibiotics for optimal outcomes ( Alrawashdeh et al., 2021 ). Health systems should consider the potential multifaceted benefits of widespread MOUD availability in terms of improved inpatient outcomes and reductions in intensive service utilization.…”