COVID-19 With Opioid, Cocaine Use Increases Endocarditis Risk

There was an increased risk for endocarditis among individuals with opioid or cocaine use disorders who were infected with COVID-19.

Individuals with opioid or cocaine use disorders who are infected with COVID-19 were at increased risk for endocarditis, according to results of a study published in Molecular Psychiatry.

Investigators from Case Western Reserve University School of Medicine and the National Institutes of Health sourced data for this study from the TriNetX Analytics Network platform. Electronic health records from 77 health care organizations located in all 50 states in the United States were evaluated for a risk for endocarditis among patients with opioid use disorder (OUD) or cocaine use disorder (CocaineUD) on the basis of contracting COVID-19. A propensity score matching approach was used to balance cohort differences.

After propensity matching, the OUD cohorts with (n=46,362) and without (n=46,362) COVID-19 were a mean age of 47.7 and 47.9 years, 53.4% and 52.9% were women, and 72.8% and 73.2% were White, respectively. The CocaineUD cohorts with (n=22,420) and without (n=22,420) COVID-19 were a mean age of 46.1 and 46.2 years, 41.1% and 40.9% were women, and 51.1% and 51.1% were White, respectively.

Overall, the incidence of endocarditis has been increasing among patients with OUD, from 3.7 per 1,000,000 persons per day in 2011 to 30.1 per 1,000,000 persons per day in 2020 (P <.001). A similar trend was observed for CocaineUD (P <.001), and no trend was observed among the non-OUD and non-CocaineUD population (P =.07).

COVID-19 is a significant risk factor for endocarditis in patients with cocaine or opioid use disorder and that the 180-day risk for mortality following COVID-19-associated endocarditis in patients with cocaine or opioid use disorder was substantial.

COVID-19 infection was associated with an increased risk for endocarditis in the population with OUD overall (hazard ratio [HR], 2.23; 95% CI, 1.92-2.60), as well as among those aged 44 years and younger (HR, 2.05), 45 to 64 years (HR, 3.44), and 65 years and older (HR, 2.17). The risk for infective endocarditis was also associated with COVID-19 overall (HR, 2.19; 95% CI, 1.82-2.62) and among those aged 44 years and younger (HR, 2.22), 45 to 64 years (HR, 3.65), and 65 years and older (HR, 2.01).

For CocaineUD, endocarditis risk followed a similar trend as observed with OUD whereas infective endocarditis was associated with COVID-19 overall (HR, 1.74; 95% CI, 1.31-2.30) and those aged 44 years and younger (HR, 1.94) and 45 to 64 years (HR, 2.31), but not 65 years and older (HR, 1.76).

In the setting of OUD and COVID-19, women were at decreased risk for endocarditis comapred with men (HR, 0.81), Black patients were at lower risk than White patients (HR, 0.59), and Hispanic patients were at lower risk than non-Hispanic patients (HR, 0.36). For CocaineUD, Black patients were at decreased risk for endocarditis than White patients (HR, 0.59) and Hispanic patients at lower risk than non-Hispanic patients (HR, 0.38).

Overall, mortality at 180 days following a new diagnosis of endocarditis was increased among patients with COVID-19 (HR, 1.21; 95% CI, 1.07-1.35) but not among patients without COVID-19 (HR, 1.16; 95% CI, 0.83-1.61).

The major limitation of this study was the cross-sectional design which did not allow for causal inferences to be made.

Study authors concluded, “COVID-19 is a significant risk factor for endocarditis in patients with cocaine or opioid use disorder and that the 180-day risk for mortality following COVID-19-associated endocarditis in patients with cocaine or opioid use disorder was substantial.”

References:

Wang L, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Association of COVID-19 with endocarditis in patients with cocaine or opioid use disorders in the US. Mol Psychiatry. Published online December 13, 2022. doi:10.1038/s41380-022-01903-1