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

{ 'indexed': {'date-parts': [[2022, 8, 5]], 'date-time': '2022-08-05T12:42:01Z', 'timestamp': 1659703321448}, 'reference-count': 31, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2022, 8, 5]], 'date-time': '2022-08-05T00:00:00Z', 'timestamp': 1659657600000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2022, 8, 5]], 'date-time': '2022-08-05T00:00:00Z', 'timestamp': 1659657600000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [ { 'DOI': '10.13039/100016206', 'name': 'UCLA Clinical and Translational Science Institute', 'doi-asserted-by': 'crossref', 'award': ['UL1TR001881']}, {'name': 'NIH/NCATS', 'award': ['KL2TR001882']}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, '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>', 'DOI': '10.1186/s42238-022-00152-x', 'type': 'journal-article', 'created': {'date-parts': [[2022, 8, 5]], 'date-time': '2022-08-05T12:19:54Z', 'timestamp': 1659701994000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: a ' 'retrospective cohort analysis', 'prefix': '10.1186', 'volume': '4', 'author': [ {'given': 'Carolyn M.', 'family': 'Shover', 'sequence': 'first', 'affiliation': []}, {'given': 'Peter', 'family': 'Yan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nicholas J.', 'family': 'Jackson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Russell G.', 'family': 'Buhr', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jennifer A.', 'family': 'Fulcher', 'sequence': 'additional', 'affiliation': []}, {'given': 'Donald P.', 'family': 'Tashkin', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-8096-0858', 'authenticated-orcid': False, 'given': 'Igor', 'family': 'Barjaktarevic', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2022, 8, 5]]}, 'reference': [ { 'key': '152_CR1', 'unstructured': '2020 National Survey of Drug Use and Health (NSDUH) Releases | CBHSQ ' 'Data. 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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.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '46'}