Abstract
Context
Patients with end-stage liver disease (ESLD) commonly experience pain and other symptoms
that result in a poor quality of life. Few studies have examined opioid usage, adverse
events (AEs), and other outcomes in ESLD patients receiving opioid analgesia.
Objectives
This study aimed to compare outcomes in ESLD patients who received opioids to those
who did not and to determine risk factors for AEs.
Methods
This was a retrospective case-cohort study of 270 hospitalized patients with ESLD
that used administrative and clinical data from the electronic medical record.
Results
Two-thirds of patients with ESLD admitted during the study period received at least
one opioid analgesic. Patients who received opioids presented with a greater number
of liver related complications and higher rates of anxiety (32% vs. 17%, P= 0.007), had substantially worse initial and average pain scores (both P< 0.001), and received more palliative care consultations. The opioid group had somewhat
more respiratory (22.2% vs. 11.1%, P= 0.02) and gastrointestinal (38.5% vs. 25.2%, P= 0.03) AEs, but no increase in CNS adverse events which included hepatic encephalopathy.
Anxiety and disease severity (i.e., the number of liver related complications) but
not opioid administration were risk factors for the number of AEs.
Conclusion
Opioid administration was not an independent risk factor for the number of AEs in
hospitalized patients with ESLD, whereas anxiety and more liver-related complications
increased AE risk. Our findings suggest that opioids have an appropriate and reasonably
safe role in alleviation of pain in patients with ESLD.
Key words
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
