High-Risk Opioid Prescriptions Associated with Hepatic Decompensation

For patients with chronic liver disease, opioid prescriptions are common, and high-risk prescriptions are associated with hepatic decompensation, especially ascites.

Research from the University of Pittsburgh Medical System found that opioid prescribing is common in patients with chronic liver disease (CLD) and that high-risk opioid prescriptions were associated with hepatic decompensation events, particularly ascites, in those patients.

The study was presented by Shari S. Rogal, MD, MPH, assistant professor of surgery at the University of Pittsburgh and investigator for the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting in San Francisco, California.

“Pain is common in patients with chronic liver disease (CLD), but few studies have assessed the impacts of opioids in this population,” wrote the study authors led by Rogal. “We aimed to describe opioid prescribing to patients with CLD and the associations between opioid prescriptions and hepatic decompensation.”

The investigators identified patients in the University of Pittsburgh Medical System using outpatient or inpatient ICD-10 codes for chronic liver disease between October 2015 and October 2016. They collected baseline data including demographic, comorbid, and liver-related factors for the year prior.

The study included 12,425 patients with chronic liver disease. The mean age was 58±13 and 23% of patients had baseline cirrhosis. The most common etiology of CLD was non-alcoholic fatty liver disease (34%).

Additionally, the research team gathered information on opioid prescriptions from pharmacy data and used ICD-9 codes for hepatic decompensation events through February 2017. High-risk opioid prescriptions were defined as those with a dose of >90 mg morphine equivalents per day and/or co-prescriptions with any benzodiazepines.

Investigators found that over the follow-up period, 22% of patients received an opioid prescription. Of those patients, 35% received opioid prescriptions considered high-risk.

“Opioid prescribing was common in this cohort of patients with CLD,” concluded Rogal and colleagues. “High-risk opioid prescriptions were significantly associated with new hepatic decompensation events.”

Certain factors were associated with the high-risk prescriptions, including, perhaps unsurprisingly, chronic pain (adjusted odds ratio [AOR] = 2.2, 95% CI = 1.9-2.6). Other factors associated with high-risk prescriptions included age (AOR per year = .99, 95% CI = .98-.99), female sex (AOR = 1.2, 95% CI = 1.1-1.4), white race (AOR = 1.9, 95% CI = 1.4-2.6), Medicaid insurance (AOR = 1.4, 95% CI = 1.1-1.7), depression (AOR = 1.4, 95% CI = 1.1-1.6), anxiety (AOR = 1.7, 95% CI = 1.4-2.1), substance use disorders (AOR = 1.8, 95% CI = 1.4-2.4), and Charlson comorbidity score (AOR/point = 1.1, 95% CI = 1.0-1.2).

The study found 521 new diagnoses of hepatic decompensation during the follow-up period in the 11,339 patients who had no previous history of hepatic decompensation. The majority of those new hepatic decompensation events (56%) were due to ascites.

Finally, after controlling for baseline factors, high-risk opioid prescriptions were found to be statistically significantly associated with new hepatic decompensation events over the follow-up period (adjusted hazard ratio = 2.6, 95% CI = 1.9-3.6).

The abstract, “2008 Opioid Prescribing to Patients with Chronic Liver Disease Is Associated with New Hepatic Decompensation,” was presented last month at the American Association for the Study of Liver Diseases (AASLD; Liver Meeting) in San Francisco, CA.