The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

Ruchi Bhandari,Cassandra Bambrick,R Constance Wiener,Christopher Waters

doi:10.31487/j.jicoa.2021.03.08

Abstract

Patients with opioid use disorder are more likely to get coronavirus disease 2019 (COVID-19). Cardiovascular diseases frequently present in COVID-19 patients and can increase their susceptibility to invasive infectious diseases, such as infective endocarditis (IE). This study examines the difference in IE incidence following COVID-19 diagnosis between individuals with and without non-medical opioid use. De-identified electronic medical records data were retrieved from TriNetX, a web-based database. Patients in the U.S., aged 18-60 years, with a diagnosis of COVID-19 during January 2020 - January 2021 were included in this study. Development of IE was determined within three months after COVID-19 diagnosis. Logistic regression was conducted to estimate the risk of developing IE between COVID-19 patients with and without opioid use after propensity score matching. COVID-19 patients with non-medical opioid use had 6.8 times the risk of developing IE compared with COVID-19 patients without opioid use (95% CI: 5.44, 8.56; p<0.0001) after propensity score matching. Findings suggest a significant risk of IE among COVID-19 patients with a history of non-medical opioid use. It provides objective evidence to account for baseline opioid use in the risk assessment of IE among COVID-19 patients.

Highlights

I Opioid Use and COVID-19The opioid epidemic has become a worldwide public health problem that has many dimensions
It provides objective evidence to account for baseline opioid use in the risk assessment of infective endocarditis (IE) among COVID-19 patients
This study demonstrates significantly higher IE incidence rates among a large sample of COVID-19 patients with non-medical opioid use compared with patients without non-medical opioid use

Summary

Introduction

I Opioid Use and COVID-19The opioid epidemic has become a worldwide public health problem that has many dimensions. It is estimated that about 11.8 million U.S citizens (4.4% of the population) have non-medical opioid use [1, 2]. This includes prescription opioids and non-medical opioids, such as heroin. A nationwide retrospective case-control study of over 73 million patients showed that patients with opioid use disorder were ten times as likely to get coronavirus disease 2019 (COVID-19) compared with patients without opioid use disorder and had significantly higher prevalence of comorbidities [4]. Among the COVID-19 patients, compared with patients without substance use disorder, those with the disorder had significantly poorer outcomes related to hospitalization and death [4]. The pharmacological effects of non-medical use of drugs may facilitate COVID-19 and its poor prognosis [4]

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