Cocaine use disorder among hospitalized patients with non-Hodgkin’s lymphoma: A national study.

e19105 Background: Cocaine use disorder (CUD) continues to be a public health concern, with a documented global resurgence in recent years. Cocaine has demonstrated mutagenic and immunomodulatory properties through several mechanisms, such as oxidative stress, impaired DNA repair, dysregulation of apoptotic pathways, and altered lymphocyte signaling. Prior studies suggest a potential link between CUD and hematologic malignancies, most notably non-Hodgkin’s lymphoma (NHL). The impact of CUD on inpatient outcomes among patients with NHL is not well established, therefore we aim to characterize the association in a nationally representative cohort. Methods: We conducted a cross-sectional study using the 2016-2019 National Inpatient Sample database of adult (≥18 years) hospitalizations with NHL. CUD, NHL, and clinical outcomes were identified using ICD-10-CM diagnosis and procedure codes. The Charlson comorbidity index (CCI) was used to compare comorbidities. Significance of descriptive data was determined with chi-square tests. Multivariable logistic regression was used to evaluate the association of CUD with clinical outcomes, adjusting for demographics, CCI, human immunodeficiency virus infection, Epstein-Barr virus infection, autoimmune disease, history of organ transplant, chemotherapy or immunotherapy administration, other substance use, hospital region, type of hospital admission, and cancer stage. Survey weights were applied to generate nationally representative estimates. Results: Among 793,060 weighted hospitalizations of patients with NHL, 2,400 (0.3%) had CUD. Patients with CUD were more likely to be younger (51 vs 66 years), male (73% vs 57%), from a minority population (65% vs 25%), have Medicaid (48% vs 9%), and be in the lowest household income quartile (51% vs 23%) (all p<0.0001). After adjustment, CUD was independently associated with higher odds of mortality (aOR 1.73, 95% CI: 1.34-2.17, p<0.0001), sepsis (aOR 1.45, 95% CI: 1.28-1.65, p<0.0001), nosocomial pneumonia (aOR 2.19, 95% CI: 1.17-4.09, p=0.014), neutropenic fever (aOR 1.61, 95% CI: 1.28-2.04, p<0.0001), dialysis (aOR 2.20, 95% CI: 1.62-3.04, p<0.0001), and mechanical ventilation (aOR 1.21, 95% CI: 1.01-1.47, p=0.044). No significant associations were observed with deep vein thrombosis, pulmonary embolism, acute kidney injury, or disseminated intravascular coagulation. Conclusions: Our results demonstrate that CUD is associated with significant sociodemographic disparities and worse clinical outcomes in hospitalized patients with NHL. These findings support previous studies associating cocaine use with immune dysregulation, which may increase susceptibility to infection and critical illness. Overall, these data identify CUD as a significant risk factor and highlight the need for improved multidisciplinary management in this vulnerable population.