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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Cannabis use disorder and severe sepsis outcomes in cancer patients: Insights from a national inpatient sample
Avinaash R Sager, Rupak Desai, Maneeth Mylavarapu, Dipsa Shastri, Nikitha Devaprasad, Shiva N Thiagarajan, Deepak Chandramohan, Anshuman Agrawal, Urmi Gada, Akhil Jain
Avinaash R Sager, Internal Medicine, St. Elizabeth’s Medical Center, Boston, MA 02135, United States
Rupak Desai, Outcomes Research, Independent Researcher, Atlanta, GA 30033, United States
Maneeth Mylavarapu, Public Health, Adelphi University, Garden City, NY 11530, United States
Dipsa Shastri, Internal Medicine, East Tennessee State University, Johnson, TN 37614, United States
Nikitha Devaprasad, Shiva N Thiagarajan, Internal Medicine, SRM Medical College Hospital and Research Center, Potheri 603211, India
Deepak Chandramohan, Department of Nephrology, University of Alabama at Birmingham, Birmingham, AL 35001, United States
Anshuman Agrawal, Internal Medicine, Kasturba Hospital, Manipal 576104, India
Urmi Gada, Infectious Diseases, Deenanath Hospital, Erandwane 411004, India
Akhil Jain, Department of Hematology and Medical Oncology, University of Iowa Hospitals and Clinics, Iowa, IA 52242, United States
Co-first authors: Avinaash R Sager and Rupak Desai.
Author contributions: Sager AR, Desai R, and Jain A performed data curation, visualization, and interpretation; Sager AR and Desai R they contributed equally to this article, they are the co-first authors of this manuscript; Desai R has made significant contributions in terms of conceptualization, methodology, editorial work and executive analysis; Sager AR, Mylavarapu M, Shastri D, Devaprasad N, Thiagarajan SN, and Agrawal A wrote the manuscript; Desai R, Jain A, Mylavarapu M, Chandramohan D, and Gada U reviewed and edited the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: We used a publicly available anonymous national database with de-identified patient information and therefore did not require Institutional Review Board approval.
Informed consent statement: We used a publicly available anonymous national database without any way to trace the identity of the patients, and therefore, informed consent was not obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: We used a publicly available anonymous national database, i.e., the National Inpatient Sample (datasets from 2016 to 2020).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Akhil Jain, MD, Department of Hematology and Medical Oncology, University of Iowa Hospitals and Clinics, 200 Hawkins, Iowa, IA 52242, United States.
akhiljaindr@gmail.com
Received: August 28, 2024
Revised: January 8, 2025
Accepted: February 8, 2025
Published online: June 9, 2025
Processing time: 183 Days and 6.2 Hours
BACKGROUND
The burden of cannabis use disorder (CUD) in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.
AIM
To address this knowledge gap, especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.
METHODS
By applying relevant International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to the National Inpatient Sample database between 2016-2020, we identified CUD(+) and CUD(-) arms among adult cancer admissions with severe sepsis. Comparing the two cohorts, we examined baseline demographic characteristics, epidemiological trends, major adverse cardiac and cerebrovascular events, respiratory failure, hospital cost, and length of stay. We used the Pearson χ2 d test for categorical variables and the Mann-Whitney U test for continuous, non-normally distributed variables. Multivariable regression analysis was used to control for potential confounders. A P value ≤ 0.05 was considered for statistical significance.
RESULTS
We identified a total of 743520 cancer patients admitted with severe sepsis, of which 4945 had CUD. Demographically, the CUD(+) cohort was more likely to be younger (median age = 58 vs 69, P < 0.001), male (67.9% vs 57.2%, P < 0.001), black (23.7% vs 14.4%, P < 0.001), Medicaid enrollees (35.2% vs 10.7%, P < 0.001), in whom higher rates of substance use and depression were observed. CUD(+) patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities. There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+) and CUD(-) cohorts on multivariable regression analysis. However, the CUD(+) cohort had lower all-cause mortality (adjusted odds ratio = 0.83, 95% confidence interval: 0.7-0.97, P < 0.001) and respiratory failure (adjusted odds ratio = 0.8, 95% confidence interval: 0.69-0.92, P = 0.002). Both groups had similar median length of stay, though CUD(+) patients were more likely to have higher hospital cost compared to CUD(-) patients (median = 94574 dollars vs 86615 dollars, P < 0.001).
CONCLUSION
CUD(+) cancer patients with severe sepsis, who tended to be younger, black, males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure. Future research should aim to better elucidate the underlying mechanisms for these observations.
Core Tip: Cannabis use disorder (CUD) in cancer patients with severe sepsis is associated with lower in-hospital mortality and respiratory failure despite higher rates of substance use and depression. CUD(+) patients, who are more likely to be younger, male, and black, also face increased hospital costs. These findings highlight the complex interplay between CUD and sepsis outcomes in cancer, suggesting the need for further research into the mechanisms behind these observations.
