Cannabis use disorder and severe sepsis outcomes in cancer patients: Insights from a national inpatient sample

Table 1 Baseline demographics, hospital-specific admitting characteristics and co-morbidities among cancer patients admitted for severe sepsis with vs without cannabis use disorder

Baseline characteristics of cancer patients hospitalized with severe sepsis (n = 743520)	CUD(-) (n = 738575)	CUD(+) (n = 4945)	P value
Demographics
Age at admission, years (median with 25th-75th percentile values)	69 (61-77)	58 (49-64)	< 0.001
Sex	-	-	< 0.001
Males	57.2	67.9	-
Females	42.8	32.1	-
Race	-	-	< 0.001
White	70.8	64.8	-
Black	14.4	23.7	-
Hispanic	10	9.5	-
Asian or Pacific Islander	4.3	1.1	-
Native American	0.6	0.9	-
Median household income1	-	-	< 0.001
0th-25th	27.2	36.7	-
26th-50th	25	26.9	-
51th-75th	24.6	21.5	-
76th-100th	23.2	14.9	-
Payer type	-	-	< 0.001
Medicare	66.1	38.2	-
Medicaid	10.7	35.2	-
Private	21.4	22.4	-
Self-pay	1.8	4.1	-
No charge	0.1	0.1	-
Hospital-specific admitting characteristics	-	-	-
Hospital location and teaching status2	-	-	< 0.001
Rural	6	5.6	-
Urban non-teaching	19.5	15.8	-
Urban teaching	74.5	78.7	-
Hospital region	-	-	< 0.001
Northeast	17.9	10.8	-
Midwest	21	20.3	-
South	36.8	34.8	-
West	24.2	34.1	-
Comorbidities
Acquired immunodeficiency syndrome	0.9	4.7	< 0.001
Diabetes without chronic complications	11	7.3	< 0.001
Diabetes with chronic complications	18.8	12.9	< 0.001
Hypertension, complicated	29.6	19.3	< 0.001
Hypertension, uncomplicated	29.4	31	0.012
Hyperlipidemia	31.1	20.3	< 0.001
Chronic pulmonary disease	26.1	34.8	< 0.001
Obesity	12	10.4	0.001
Peripheral vascular disease	7.6	8.2	0.11
Hypothyroidism	13.2	7.3	< 0.001
Valvular disease	1.1	0.3	< 0.001
Tobacco use	25.2	28.8	< 0.001
Alcohol abuse	2.9	13.1	< 0.001
Cocaine use	0.2	6.9	< 0.001
Depression	9.8	16.2	< 0.001
Prior myocardial infarction	4.5	4.7	0.521
Prior transient ischemic attack or stroke	4.4	3.7	0.022
Prior cancer	15.3	14.3	0.038
Prior chemotherapy	9.6	12.2	< 0.001
Prior radiotherapy	6.6	8.9	< 0.001
Autoimmune conditions	3	2.2	0.003

¹Quartile classification of estimated median household income based on patients' ZIP code, https://hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nrdnote.jsp

²A teaching hospital is one that has at least one Accreditation Council for Graduate Medical Education-approved residency program. Urban/rural classification is designated by Core Based Statistical Area, https://hcup-us.ahrq.gov/db/vars/hosp_bedsize/nrdnote.jsp

Values are in percentages unless specified. Accompanying P value for significance. CUD: Cannabis use disorder.

Table 2 Primary and secondary in-hospital outcomes among cancer patients admitted for severe sepsis with vs without cannabis use disorder

Outcomes	CUD(-) (n = 738575)	CUD(+) (n = 4945)	P value
MACCE	36	28.4	< 0.001
All-cause in-hospital mortality	30.5	23.4	< 0.001
Acute myocardial infarction	7.2	5.5	< 0.001
Cardiac arrest, ventricular fibrillationand ventricular flutter	0.6	0.8	0.038
Acute ischemic stroke	2	1.7	0.207
Respiratory failure	50.9	48.6	0.002
Disposition of patient1	-	-	< 0.001
Routine	18.8	31.5	-
Transfer to short term facility	3.4	3	-
Other transfers (SNF, ICF etc.)	25.8	17.8	-
Home healthcare	21	21.8	-
Length of stay (median, days)	7	7	0.034
Total cost of hospitalization (median, USD)	86615	94574	< 0.001

¹Disposition is at time of discharge and subject to state-specific differences in classification, https://hcup-us.ahrq.gov/db/vars/disp/nisnote.jsp

Values are in percentages unless stated. Accompanying 95% confidence intervals and P values for significance. CUD: Cannabis use disorder; MACCE: Major adverse cardiac and cerebrovascular events; SNF: Skilled nursing facility, ICF: Intermediate care facility; USD: United States dollar.

Table 3 Multivariable regression analysis of primary outcomes comparing cancer patients admitted for severe sepsis with vs without cannabis use disorder

Events	Adjusted OR	95%CI	P value
MACCE	0.86	0.74-1.01	0.059
All-cause in-hospital mortality	0.83	0.7-0.97	0.022
Acute myocardial infarction	1.03	0.77-1.37	0.84
Cardiac arrest, ventricular fibrillationand ventricular flutter	1.14	0.51-2.52	0.754
Acute ischemic stroke	0.89	0.53-1.5	0.671
Respiratory failure	0.8	0.69-0.92	0.002

Values are as adjusted odds ratios. Accompanying 95% confidence intervals and P values for significance. Factors adjusted for are age, sex, race, median household income, payer type, elective status, hospital bed size, hospital location and teaching status, hospital region, acquired immunodeficiency syndrome, autoimmune conditions, depression, diabetes with and without chronic complications, hypertension (complicated and uncomplicated), hyperlipidemia, chronic pulmonary disease, obesity, peripheral vascular disease, hypothyroidism, valvular disease, drug abuse, alcohol abuse, smoker status, cocaine abuse, prior myocardial infarction, prior transient ischemic attack or stroke, and prior cancer history. OR; Odds ratio; CI: Confidence interval; MACCE: Major adverse cardiac and cerebrovascular events.