Opioids Associated With Increased Mortality Among Liver Cirrhosis Patients

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.