Opioids Associated With Increased Mortality Among Liver Cirrhosis Patients

Among patients with liver cirrhosis, opioids are associated with increased mortality.

BOSTON, MA—Opioid use among patients with liver cirrhosis is associated with significantly elevated mortality, researchers reported at The Liver Meeting® 2016.

“Opioid use was independently related with sepsis-related death, time to overall death, and time to sepsis-related death,” reported lead study author Steven J. Scaglione, MD, of Loyola University Medical Center, Maywood, IL.

Nearly 30% of patients with liver cirrhosis take opioid medications, Dr. Scaglione noted. Among patients with cirrhosis, opioids increase the incidence of inflammation, pain, psychiatric symptoms, and increased health-care utilization. 

The research team sought to evaluate whether it is also associated with increased mortality in a single-center study of 468 patients with liver cirrhosis, conducted between October 2012 and December 1, 2015. A total of 139 (29.7%) were taking opioids; the other 329 (70.2%) were not on opioids. 

Average patient age was 59.8 years for patients on pain-reliever opioids and 58.1 years for those not on opioids; 51% and 56.5%, respectively, were male. Forty (28.8%) patients on opioids were hepatitis C virus (HCV)-positive compared to 116 (35.3%) of those not on opioids. Ninety-seven (69.8%) of opioids-taking patients had ascites, compared to 169 (51.3%) in the non-opioids cohort.

Other causes of liver disease included alcohol (42.5% for opioids cohort; 36% for non-opioids group) and NASH (23%; 25%).

Tramadol use was associated with sepsis-related death (odds ratio [OR] 6.4; 95% CI: 1.07–38.6; P=0.041) and overall death (OR 3.6; 95% CI: 1.35-9.9; P=0.011). 

For narcotics, the OR for sepsis-related death was 8.4 (95% CI: 1.2–59; P=0.33), and for overall death, 3.4 (95% CI: 1–11.3; P=0.049).

“More research is needed to identify the etiology of increased mortality with narcotic pain medication use in the cirrhotic population,” Dr. Scaglione concluded.