S2603 Unmasking the Hidden Toll of Cannabis Use in Cirrhosis: A Real-World Analysis of Mortality, Critical Care Utilization, and Electrolyte Imbalance

Introduction: Cannabis use is increasingly prevalent among patients with chronic liver disease, yet its clinical impact on outcomes in cirrhosis remains unclear. This study evaluates the association between cannabis use disorder and a range of clinical complications in patients with cirrhosis, using a large U.S. electronic health record database. Methods: We conducted a retrospective, propensity-matched cohort study using U.S. electronic health record data from the TriNetX network. Adults aged 18–89 years with cirrhosis were divided into 2 cohorts: those with cannabis use disorder (n = 45,199) and those without (n = 814,071). Propensity score matching (1:1) was performed based on age, sex, and key laboratory values including sodium, creatinine, hemoglobin, platelets, alanine aminotransferase, aspartate aminotransferase, bilirubin, and INR. This yielded patients in each group (n = 45,022). Outcomes were assessed over a 1-year follow-up and included respiratory complications, dyselectrolytemia, hepatic decompensation, and mortality. Odds ratios (OR) with 95% confidence intervals (CI) were used for comparison. Results: Compared to cirrhosis patients without cannabis use, those with cannabis use disorder had significantly higher odds of all-cause mortality (OR 1.103, 95% CI 1.068–1.139), critical care admission (OR 1.492, 95% CI 1.436–1.550), pneumonia (OR 1.314, 95% CI 1.254–1.376), pneumothorax (OR 1.138, 95% CI 1.021–1.268), and hypoalbuminemia (OR 1.118, 95% CI 1.077–1.610). Dyselectrolytemia was more frequent in the cannabis group, including hyponatremia (OR 1.309, 95% CI 1.256–1.365), hypernatremia (OR 1.390, 95% CI 1.295–1.491), hypokalemia (OR 1.385, 95% CI 1.326–1.446), and hyperkalemia (OR 1.138, 95% CI 1.087–1.192). Hemothorax also showed a significant association (OR 1.244, 95% CI 1.061–1.459). Empyema was not significantly associated with cannabis use (OR 1.092, 95% CI 0.922–1.292). Conclusion: Cannabis Use Disorder (CUD) in cirrhosis is linked to worse clinical outcomes, including increased mortality, ICU use, respiratory issues, and dyselectrolytemia. These effects may stem from immune modulation, inhalational exposure, renal interactions, and metabolic disruption associated with cannabis. While causality cannot be confirmed, the findings suggest clinicians should routinely screen for cannabis use, monitor closely for related complications, and counsel patients on potential risks. Further prospective research is needed to better define the mechanisms and long-term impact of cannabis in advanced liver disease.