Higher Mortality Associated With Opioid Use in Patients With Sepsis

The use of prescription opioids in hospitalized patients with sepsis resulted in a significantly higher risk of death, according to research published in PLoS One.

Opioids are commonly prescribed for hospitalized patients; however, the negative effects associated with this treatment have only recently received attention. To evaluate clinical outcomes of opioid use in patients with sepsis, data collected from electronic health records (EHRs) and other sources from a multi-institutional health system in Minnesota for 5994 patients with sepsis (of which 4540 were treated with opioids) were analyzed.

Baseline characteristics such as mean body mass index (BMI), mean white blood cell count, mean respiratory rate, Charlson comorbidity score, positive microbiological culture, sepsis diagnosis, and sex were significantly different between the opioid and non-opioid groups. 

Crude 28-day mortality for patients treated with opioids was 10.35% compared with 2.40% for the non-opioid group. Further analysis, adjusting for opioid exposure time, confounders such as demographics, comorbidities, severity of illness, and type of infection, showed that opioid use is associated with higher mortality in septic patients.

Results also indicated that prescription opioid treatment was associated with increased incidence of positive microbial culture. This, along with the higher mortality “implies that the immunosuppressive effects of opioids might contribute to the worse outcome of sepsis.” However, other factors might not be accurately stored in EHRs; thus, randomized clinical studies are needed to determine mortality rates in a variety of scenarios (eg, differences in opioid regimens, antibiotic use, and exploring a dose-dependent association between opioid use and mortality).

Reference

Zhang R, Meng J, Lian Q, et al. Prescription opioids are associated with higher mortality in patients diagnosed with sepsis: a retrospective cohort study using electronic health records. PLoS One. 2018;13(1): e0190362.