S2393 Impact of Cannabis Use on the Outcomes of Liver Cirrhosis: A US National Retrospective Cohort Study

Introduction: After the legalization of the cannabis, cannabis use has surpassed the cigarettes smoking per CDC data in 2023. There is no concrete data on the safety of cannabis use in liver cirrhosis patients and how it impacts various liver-related and other outcomes in this special set of population. Methods: We queried the U.S. electronic health record data from the TriNetX network for patients aged 18-89 years with liver cirrhosis and categorized them into 2 cohorts (cohort 1: cirrhosis + cannabis use disorder; cohort 2: cirrhosis - cannabis use disorder). Propensity score matching (PSM) was conducted for demographic variables and key laboratory values. Outcomes were assessed over a 1 year follow-up period and included infectious complications, liver-related outcomes, all-cause mortality, and healthcare utilization. Results: After propensity matching, 45,022 patients were included in each cohort. Patients with cirrhosis and cannabis use disorder had significantly higher risks of dehydration (OR 1.470, 95% CI 1.399-1.544), sepsis (OR 1.315, 95% CI 1.260-1.374), septic shock (OR 1.303, 95% CI 1.248-1.361), SBP (OR 1.228, 95% CI 1.140-1.322), pneumonia (OR 1.314, 95% CI 1.254-1.376), hepatic encephalopathy (OR 1.158, 95% CI 1.097-1.223), and acute kidney injury (OR 1.240, 95% CI 1.192-1.290) compared to no cannabis users. Cannabis use in liver cirrhosis was associated with higher odds of inpatient hospitalization (OR 1.405, 95% CI 1.386-1.424), and ER visits (OR 1.424, 95% CI 1.398-1.450) than non-users. All-cause mortality (OR 1.103, 95% CI 1.068-1.139) was higher but liver transplantation rates (OR 0.568, 95% CI 0.524-0.616) were lower in the cannabis use cohort than non-users. Conclusion: Our study identifies the increased risk of adverse clinical outcomes associated with cannabis use disorder in liver cirrhosis patients. This may be attributed to the effects of cannabis on cardiovascular function, neuromodulation and suppression, immune modulation, and gastrointestinal motility which may predispose vulnerable cirrhotic patients to complications like dehydration, acute kidney injury, encephalopathy, and infectious complications and hence lead to increased healthcare utilization. Cannabis use ultimately led to worsened all-cause mortality in this special subset of the population, highlighting the need for increased awareness and education of both patients and physicians equally, on the detrimental effects of cannabis use in liver cirrhosis.