Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Moon, AM; Jiang, Y; Rogal, SS; Tapper, EB; Lieber, SR; Barritt, AS

Published Date

  • March 2020

Published In

Volume / Issue

  • 51 / 6

Start / End Page

  • 652 - 660

PubMed ID

  • 31960985

Pubmed Central ID

  • PMC7047528

Electronic International Standard Serial Number (EISSN)

  • 1365-2036

International Standard Serial Number (ISSN)

  • 0269-2813

Digital Object Identifier (DOI)

  • 10.1111/apt.15639

Language

  • eng