Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: a retrospective cohort analysis

DOI record: { "DOI": "10.1186/s42238-022-00152-x", "ISSN": [ "2522-5782" ], "URL": "http://dx.doi.org/10.1186/s42238-022-00152-x", "abstract": "<jats:title>Abstract</jats:title><jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>While cannabis is known to have immunomodulatory properties, the clinical consequences of its use on outcomes in COVID-19 have not been extensively evaluated. We aimed to assess whether cannabis users hospitalized for COVID-19 had improved outcomes compared to non-users.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>We conducted a retrospective analysis of 1831 patients admitted to two medical centers in Southern California with a diagnosis of COVID-19. We evaluated outcomes including NIH COVID-19 Severity Score, need for supplemental oxygen, ICU (intensive care unit) admission, mechanical ventilation, length of hospitalization, and in-hospital death for cannabis users and non-users. Cannabis use was reported in the patient’s social history. Propensity matching was used to account for differences in age, body-mass index, sex, race, tobacco smoking history, and comorbidities known to be risk factors for COVID-19 mortality between cannabis users and non-users.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>Of 1831 patients admitted with COVID-19, 69 patients reported active cannabis use (4% of the cohort). Active users were younger (44 years vs. 62 years, <jats:italic>p</jats:italic> &lt; 0.001), less often diabetic (23.2% vs 37.2%, <jats:italic>p</jats:italic> &lt; 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, <jats:italic>p</jats:italic> &lt; 0.001) compared to non-users. Notably, active users had lower levels of inflammatory markers upon admission than non-users—CRP (C-reactive protein) (3.7 mg/L vs 7.6 mg/L, <jats:italic>p</jats:italic> &lt; 0.001), ferritin (282 μg/L vs 622 μg/L, <jats:italic>p</jats:italic> &lt; 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, <jats:italic>p</jats:italic> = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, <jats:italic>p</jats:italic> = 0.001). Based on univariate analysis, cannabis users had significantly better outcomes compared to non-users as reflected in lower NIH scores (5.1 vs 6.0, <jats:italic>p</jats:italic> &lt; 0.001), shorter hospitalization (4 days vs 6 days, <jats:italic>p</jats:italic> &lt; 0.001), lower ICU admission rates (12% vs 31%, <jats:italic>p</jats:italic> &lt; 0.001), and less need for mechanical ventilation (6% vs 17%, <jats:italic>p</jats:italic> = 0.027). Using propensity matching, differences in overall survival were not statistically significant between cannabis users and non-users, nevertheless ICU admission was 12 percentage points lower (<jats:italic>p</jats:italic> = 0.018) and intubation rates were 6 percentage points lower (<jats:italic>p</jats:italic> = 0.017) in cannabis users.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>This retrospective cohort study suggests that active cannabis users hospitalized with COVID-19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation. However, our results need to be interpreted with caution given the limitations of a retrospective analysis. Prospective and observational studies will better elucidate the effects cannabis use in COVID-19 patients.</jats:p>\n </jats:sec>", "alternative-id": [ "152" ], "article-number": "46", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "18 January 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "3 July 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "5 August 2022" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Ethics approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "This study was reviewed and approved by the UCLA Institutional Review Board (20-000473)." }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "RGB received personal consulting fees from Viatris/Theravance Biopharma, unrelated to this work. IZB reports consulting for Astra Zeneca, GSK, Viatris/Theravance, Aerogen, Verona Pharma and Grifols. Dr. Buhr is employed by the Veterans Health Administration. The views and findings of this manuscript do not necessarily reflect the opinions of the United States Government." } ], "author": [ { "affiliation": [], "family": "Shover", "given": "Carolyn M.", "sequence": "first" }, { "affiliation": [], "family": "Yan", "given": "Peter", "sequence": "additional" }, { "affiliation": [], "family": "Jackson", "given": "Nicholas J.", "sequence": "additional" }, { "affiliation": [], "family": "Buhr", "given": "Russell G.", "sequence": "additional" }, { "affiliation": [], "family": "Fulcher", "given": "Jennifer A.", "sequence": "additional" }, { "affiliation": [], "family": "Tashkin", "given": "Donald P.", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-8096-0858", "affiliation": [], "authenticated-orcid": false, "family": "Barjaktarevic", "given": "Igor", "sequence": "additional" } ], "container-title": "Journal of Cannabis Research", "container-title-short": "J Cannabis Res", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2022, 8, 5 ] ], "date-time": "2022-08-05T12:19:54Z", "timestamp": 1659701994000 }, "deposited": { "date-parts": [ [ 2022, 8, 5 ] ], "date-time": "2022-08-05T12:20:46Z", "timestamp": 1659702046000 }, "funder": [ { "DOI": "10.13039/100016206", "award": [ "UL1TR001881" ], "doi-asserted-by": "crossref", "name": "UCLA Clinical and Translational Science Institute" }, { "award": [ "KL2TR001882" ], "name": "NIH/NCATS" } ], "indexed": { "date-parts": [ [ 2022, 8, 5 ] ], "date-time": "2022-08-05T12:42:01Z", "timestamp": 1659703321448 }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2022, 8, 5 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2022, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 8, 5 ] ], "date-time": "2022-08-05T00:00:00Z", "timestamp": 1659657600000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 8, 5 ] ], "date-time": "2022-08-05T00:00:00Z", "timestamp": 1659657600000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1186/s42238-022-00152-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1186/s42238-022-00152-x/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1186/s42238-022-00152-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1186", "published": { "date-parts": [ [ 2022, 8, 5 ] ] }, "published-online": { "date-parts": [ [ 2022, 8, 5 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "key": "152_CR1", "unstructured": "2020 National Survey of Drug Use and Health (NSDUH) Releases | CBHSQ Data. https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases. Accessed 1 Oct 2021." }, { "DOI": "10.1186/s13054-020-03406-3", "author": "J Beigel", "doi-asserted-by": "publisher", "first-page": "677", "journal-title": "Crit Care", "key": "152_CR2", "unstructured": "Beigel J, et al. 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