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

Shover et al., Journal of Cannabis Research, doi:10.1186/s42238-022-00152-x
Aug 2022  
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0 0.5 1 1.5 2+ Mortality 2% Improvement Relative Risk Ventilation 5% ICU admission 9% Oxygen therapy 3% Cannabidiol for COVID-19  Shover et al.  Prophylaxis Is prophylaxis with cannabidiol beneficial for COVID-19? Retrospective 1,831 patients in the USA (February 2020 - February 2021) Lower ventilation (p=0.017) and ICU admission (p=0.018) c19early.org Shover et al., J. Cannabis Research, Aug 2022 Favors cannabidiol Favors control
Retrospective 1,831 hospitalized COVID-19 patients in the USA, showing lower mechanical ventilation and ICU admission, but no significant difference in mortality.
risk of death, 1.8% lower, RR 0.98, p = 0.56, treatment 3 of 69 (4.3%), control 199 of 1,762 (11.3%), odds ratio converted to relative risk, propensity score matching.
risk of mechanical ventilation, 5.1% lower, RR 0.95, p = 0.02, treatment 3 of 69 (4.3%), control 292 of 1,762 (16.6%), NNT 8.2, odds ratio converted to relative risk, propensity score matching.
risk of ICU admission, 8.6% lower, RR 0.91, p = 0.02, treatment 8 of 69 (11.6%), control 543 of 1,762 (30.8%), NNT 5.2, odds ratio converted to relative risk, propensity score matching.
risk of oxygen therapy, 2.6% lower, RR 0.97, p = 0.27, treatment 35 of 69 (50.7%), control 1,417 of 1,762 (80.4%), NNT 3.4, odds ratio converted to relative risk, propensity score weighting.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shover et al., 5 Aug 2022, retrospective, USA, peer-reviewed, 7 authors, study period 12 February, 2020 - 27 February, 2021. Contact: ibarjaktarevic@mednet.ucla.edu (corresponding author).
This PaperCannabidiolAll
Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: a retrospective cohort analysis
Carolyn M Shover, Peter Yan, Nicholas J Jackson, Russell G Buhr, Jennifer A Fulcher, Donald P Tashkin, Igor Barjaktarevic
Journal of Cannabis Research, doi:10.1186/s42238-022-00152-x
Background: 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. Methods: 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. Results: 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, p < 0.001), less often diabetic (23.2% vs 37.2%, p < 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, p < 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, p < 0.001), ferritin (282 μg/L vs 622 μg/L, p < 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, p = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, p = 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, p < 0.001), shorter hospitalization (4 days vs 6 days, p < 0.001), lower ICU admission rates (12% vs 31%, p < 0.001), and less need for mechanical ventilation (6% vs 17%, p = 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 (p = 0.018) and intubation rates were 6 percentage points lower (p = 0.017) in cannabis users. Conclusions: 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
Abbreviations Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s42238-022-00152-x. Additional file 1: Supplemental Table 1 . NIH Severity Score and Definitions (Beigel et al. 2020) . Supplemental Table 2 . Covariate balance after propensity weighting or matching. Authors' contributions JAF designed the database and obtained regulatory approvals. CMS and PY reviewed the data. CMS, NJJ, and RGB developed the analytic plan. NJJ analyzed the data. CMS, PY, RGB, DPT, and IB drafted and/or critically edited the manuscript. All authors reviewed and approved the final version of the manuscript for submission. Declarations Ethics approval and consent to participate This study was reviewed and approved by the UCLA Institutional Review Board (20-000473). Competing interests 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. • fast, convenient online submission • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased..
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' '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. 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Tobacco smoking and severity of COVID-19: ' 'Experience from a hospital-based prospective cohort study in Lyon, ' 'France. J Med Virol. 2021:10.1002/jmv.27233. ' 'https://doi.org/10.1002/jmv.27233.', 'DOI': '10.1002/jmv.27233'}, { 'key': '152_CR27', 'doi-asserted-by': 'publisher', 'first-page': '596', 'DOI': '10.1080/00952990.2019.1627366', 'volume': '45', 'author': 'DP Tashkin', 'year': '2019', 'unstructured': 'Tashkin DP, Roth MD. Pulmonary effects of inhaled cannabis smoke. Am J ' 'Drug Alcohol Abuse. 2019;45:596–609.', 'journal-title': 'Am J Drug Alcohol Abuse'}, { 'key': '152_CR28', 'doi-asserted-by': 'publisher', 'first-page': '831', 'DOI': '10.1016/S2213-2600(20)30360-X', 'volume': '8', 'author': 'The Lancet Respiratory Medicine', 'year': '2020', 'unstructured': 'The Lancet Respiratory Medicine. The EVALI outbreak and vaping in the ' 'COVID-19 era. Lancet Respir Med. 2020;8:831.', 'journal-title': 'Lancet Respir Med'}, { 'key': '152_CR29', 'doi-asserted-by': 'publisher', 'unstructured': 'van Breemen RB, et al. Cannabinoids Block Cellular Entry of SARS-CoV-2 ' 'and the Emerging Variants. J Nat Prod. 2022. ' 'https://doi.org/10.1021/acs.jnatprod.1c00946.', 'DOI': '10.1021/acs.jnatprod.1c00946'}, { 'key': '152_CR30', 'doi-asserted-by': 'publisher', 'unstructured': 'Wang L, Wang Q, Davis PB, Volkow ND, Xu R. Increased risk for COVID-19 ' 'breakthrough infection in fully vaccinated patients with substance use ' 'disorders in the United States between December 2020 and August 2021. ' 'World Psychiatry. 2021a:10.1002/wps.20921. ' 'https://doi.org/10.1002/wps.20921.', 'DOI': '10.1002/wps.20921'}, { 'key': '152_CR31', 'doi-asserted-by': 'publisher', 'first-page': '30', 'DOI': '10.1038/s41380-020-00880-7', 'volume': '26', 'author': 'QQ Wang', 'year': '2021', 'unstructured': 'Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in ' 'patients with substance use disorders: analyses from electronic health ' 'records in the United States. Mol Psychiatry. 2021b;26:30–9.', 'journal-title': 'Mol Psychiatry'}], 'container-title': 'Journal of Cannabis Research', 'original-title': [], 'language': 'en', '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'}], 'deposited': { 'date-parts': [[2022, 8, 5]], 'date-time': '2022-08-05T12:20:46Z', 'timestamp': 1659702046000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-022-00152-x'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 8, 5]]}, 'references-count': 31, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2022, 12]]}}, 'alternative-id': ['152'], 'URL': 'http://dx.doi.org/10.1186/s42238-022-00152-x', 'relation': {}, 'ISSN': ['2522-5782'], 'subject': ['General Medicine'], 'container-title-short': 'J Cannabis Res', 'published': {'date-parts': [[2022, 8, 5]]}, 'assertion': [ { 'value': '18 January 2022', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '3 July 2022', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '5 August 2022', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'This study was reviewed and approved by the UCLA Institutional Review Board ' '(20-000473).', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { '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.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '46'}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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