Abstract: d pe er re vie we Cannabis use and COVID-19 hospitalization outcomes. A retrospective study. Pr ep rin tn ot Running title: Cannabis use and COVID outcomes This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4336513 pe er re vie we Sarath Lal Mannumbeth Renjithlal1, Mohamed Magdi1, Abdullah Zoheb d Authors: Azhar1,Keerthi Renjith1, Richard Alweis1, Nayef El-Daher1, Moghniuddin Mohammed1. Affiliations 1Department of medicine, Rochester regional health/Unity hospital 2Department of Cardiology, Maimonides Medical Center, New York. Disclosure All authors have no conflict of interest Corresponding author: ot All authors received no financial support for the research, authorship, or publication tn Name: Sarath Lal Mannumbeth Renjithlal rin Email: mrlalsarath@gmail.com Sarath Lal Mannumbeth Renjithlal: Conceptualization, Methodology, Writing- ep Original draft preparation. Mohamed Magdi.:Writing and reviewing. Abdullah Zoheb Azhar: Writing and Reviewing. Keerthi Renjith: Writing . Richard Alweis: Supervision.: , Nayef El-Daher: Supervision, Reviewing, Moghniuddin Pr Mohammed : Writing, Supervision, Reviewing and Software. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4336513 d pe er re vie we Abstract Background In vitro studies have shown cannabinoids blocking SARS-CoV-2 cellular entry and affecting replication. There is a paucity of data assessing the effect of cannabis on patients hospitalized with COVID in the USA. The aim of our study was to assess mortality and complication rates in patients hospitalized with COVID stratified by cannabis use. Methods We used the National Inpatient Sample, the largest all-payer inpatient database with 95% of US hospitalizations from 49 states, to identify all COVID hospitalizations from January 01, 2020, to December 31, 2020. We included all adult patients without missing mortality and gender information. The whole cohort was stratified by cannabis use into two groups (cannabis use disorder (CUD) vs. no CUD). We performed propensity score matching based on multiple patient and hospital characteristics to assess the outcome difference. Results ot A total of 1,657,800 hospitalizations were included. Of these, 13,095 (0.79%) were cannabis users and were likely to be male (65.6%) and Black (35%) compared to non-cannabis users. tn After propensity score matching, the CUD group had lower mortality (2.9% compared to 5.5%, OR 0.43 [CI 0.34 – 0.55] p <0.001). They also had lower rates of non-invasive (2.9% vs. 3.9 p <0.014), invasive mechanical ventilation (9.4% vs. 7.1%, p<0.001) and ECMO use rin (0.1 vs. 0.3 p <0.014). They also had a lower rate of septic shock (3.1% vs. 4% p<0.03) and lesser GI bleeding (3.3% vs. 2.3% p<0.005) compared to no CUD. The cost of hospitalization in the CUD group was significantly lower. There was no significant difference between the ep other complications assessed. Pr Conclusion We found lower mortality rates, lesser need for mechanical ventilation, and reduced hospitalization expenses among cannabis users hospitalized with COVID-19. Further This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4336513 research is required to determine whether cannabinoid is a candidate for the treatment and pe er re vie we d prevention of..