The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis
Andrew M Moon1, Yue Jiang2, Shari S Rogal3, Elliot B Tapper45, Sarah R Lieber1, A Sidney Barritt 4th1
Author information
1Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
2Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
3Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
4Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
5Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Abstract
Background: Opioids are often prescribed for pain in cirrhosis and may increase the risk of hepatic encephalopathy (HE).
Aim: To assess the association between opioids and HE in patients with well-compensated cirrhosis.
Methods: We used the IQVIA PharMetrics (Durham, NC) database to identify patients aged 18-64 years with cirrhosis. We excluded patients with any decompensation event from 1 year before cirrhosis diagnosis to 6 months after cirrhosis diagnosis. Over the 6 months after cirrhosis diagnosis, we determined the duration of continuous opioid use and classified use into short term (1-89 days) and chronic (90-180 days). We assessed whether patients developed HE over the subsequent year (ie 6-18 months after cirrhosis diagnosis). We used a landmark analysis and performed multivariable Cox proportional hazards regression to assess associations between opioid use and HE, adjusting for relevant confounders.
Results: The cohort included 6451 patients with compensated cirrhosis, of whom 23.3% and 4.7% had short-term and chronic opioid prescriptions respectively. Over the subsequent year, HE occurred in 6.3% patients with chronic opioid prescriptions, 5.0% with short-term opioid prescriptions and 3.3% with no opioid prescriptions. In the multivariable model, an increased risk of HE was observed with short-term (adjusted hazard ratio, HR 1.44, 95% CI 1.07-1.94) and chronic opioid prescriptions (adjusted HR 1.83, 95% CI 1.07-3.12) compared to no opioid prescriptions.
Conclusion: In this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE. Opioid use should be minimised in those with cirrhosis and, when required, limited to short duration.
Stay Informed!
