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Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis.
Alimentary Pharmacology & Therapeutics ( IF 7.6 ) Pub Date : 2020-01-21 , DOI: 10.1111/apt.15639
Andrew M Moon 1 , Yue Jiang 2 , Shari S Rogal 3 , Elliot B Tapper 4, 5 , Sarah R Lieber 1 , A Sidney Barritt 1
Affiliation  

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.

中文翻译:

在全国代偿性肝硬化患者队列中,阿片类药物处方与肝性脑病有关。

背景技术阿片类药物通常被处方用于肝硬化的疼痛,并且可能增加肝性脑病(HE)的风险。目的评估充分补偿的肝硬化患者中阿片类药物与HE的相关性。方法我们使用IQVIA PharMetrics(北卡罗来纳州达勒姆)数据库来识别年龄在18-64岁之间的肝硬化患者。从肝硬化诊断前1年到肝硬化诊断后6个月,我们排除了发生任何代偿失调事件的患者。在肝硬化诊断后的6个月内,我们确定了持续使用阿片类药物的持续时间,并将其分为短期使用(1-89天)和长期使用(90-180天)。我们评估了患者在接下来的一年(即肝硬化诊断后6-18个月)是否发展为HE。我们使用了地标性分析并进行了多变量Cox比例风险回归,以评估阿片类药物使用与HE的相关性,并调整相关的混杂因素。结果该队列包括6451例代偿性肝硬化患者,其中分别使用短期和慢性阿片类药物处方的占23.3%和4.7%。在随后的一年中,发生慢性阿片类药物处方的患者占6.3%,使用短期阿片类药物处方的患者占5.0%,无阿片类药物处方的患者占3.3%。在多变量模型中,短期(调整后的危险比,HR 1.44,95%CI 1.07-1.94)和慢性阿片类药物处方(调整后的HR 1.83,95%CI 1.07-3.12)观察到HE的风险增加,而没有使用阿片类药物阿片类药物处方。结论在这个全国范围内的私人参保肝硬化患者中,阿片类药物处方与发生HE的风险有关。肝硬化患者应尽量减少使用阿片类药物,并在需要时限制使用时间短。
更新日期:2020-01-22
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