(600) Impact of Substance Use Disorders on Short-Term Mortality in Critically Ill Patients With COVID-19

Introduction: Substance use disorders (SUD) are associated with increased risk of COVID-19 infection and rate of ICU admission once infected, compared to the general population. Evidence is conflicting on the association of SUD with mortality among patients with COVID-19. SUD are not associated with mortality in critically ill patients in the general population. We examined the population-level association of SUD with short-term mortality in critically ill patients with COVID-19.

Methods: We used a statewide dataset to identify ICU admissions aged ≥18 years with a principal diagnosis of COVID-19 in Texas during April 1, 2020-December 31, 2022. COVID-19 was defined by ICD-10 code U07.1. SUD were defined by ICD-10 codes under Clinical Classifications Software Refined categories MBD018-MBD023. Hierarchical logistic models were fit to estimate the association of SUD with short-term mortality (defined as in-hospital death or discharge to hospice) among ICU admissions. Sensitivity analyses were performed for individual substance use categories.

Results: Among 153,973 ICU admissions, 2,153 (1.4%) had SUD, of which opiate, cannabis, sedative, stimulant, hallucinogen, and inhalant use disorders were 25.1%, 39.9%, 6.0%, 40.8%, 0.7%, and 0.1%, respectively. Compared to those without SUD, those with SUD were younger (aged 18-44 years, 32.0% vs 15.2%), more commonly racial & ethnic minority (56.6% vs 53.1%), and lacking health insurance (12.8% vs 7.1%), with higher mean [SD] Charlson Comorbidity Index (1.6 [1.8] vs 1.4 [1.8]), and slightly higher number of organ dysfunctions (1.6 [1.3] vs 1.6 [1.2]). Short-term mortality among ICU admissions with and without SUD was 14.0% vs 20.8%, respectively, ranging from 8.2% in those with cannabis use to 22.0% in those with opiate use. On adjusted analyses, the risk of short-term mortality was lower among ICU admissions with SUD overall (adjusted odds ratio [aOR] 0.58 [95% CI 0.48-0.70] vs those without SUD) and in those with opiate (aOR 0.56 [0.40-0.77]), cannabis (aOR 0.66 [0.46-0.93]), sedative (aOR 0.30 [0.15-0.62]), and stimulant (aOR 0.62 [0.46-0.84]) use disorders.

Conclusions: SUD were associated with nearly 40% lower risk of short-term mortality among critically ill patients with COVID-19 overall, with consistently lower odds of death among the examined SUD categories.