Inpatient Outcomes in Patients with Cyclic Vomiting Syndrome and Cannabis Use Disorder: A Retrospective Study

Abstract

Please see supplemental content for full abstract with tables.

Background: Cyclic vomiting syndrome (CVS) is an idiopathic disorder characterized by recurrent bouts of vomiting with intervening periods of normal health. It is commonly seen in young adults with symptoms of nausea, vomiting and dehydration. It can also lead to multiple complications including, electrolyte derangements, metabolic alkalosis, and esophageal injury. With increasing use of cannabis in United States for medicinal and recreational purposes, the impact of its use in different patient populations remains unclear. Therefore, in this study, we aimed to assess the burden and impact of cannabis use disorder (CUD) on inpatient outcomes in patients admitted with cyclic vomiting syndrome.

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Methods: The Hospital Corporation of America (HCA) corporate database from 2016 to 2021 with relevant ICD-10 codes were used to identify patients with cyclic vomiting syndrome and cannabis use disorder (CUD). We compared demographics, including age and sex, and outcomes of patients with cyclic vomiting syndrome with vs without cannabis use disorder (CUD). Outcome variables were all-cause mortality, length of hospital stay, acute kidney injury (AKI), sepsis, shock, intestinal obstruction, and encephalopathy, compared between CUD vs non-CUD cohort among hospitalized patients with cyclic vomiting syndrome. Multivariate regression analysis was also performed adjusting for demographics.

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Results:A total of 10179 adult patients (age 18-90) with cyclic vomiting syndrome were identified in our study, of which 2515 (24.71%) had a reported cannabis use disorder. The CUD cohort had a median age of 32.6, as compared to 33.3 in non-CUD cohort. It consisted predominantly of female patients (54.08%). Among inpatients outcomes, the CUD cohort had a higher rate of acute kidney injury (AKI) (12.52%) as compared to non-CUD cohort (2.74%) with statistical significance (p value

Conclusion: Our study showed higher rate of development of acute kidney injury and sepsis in patients with cannabis use disorder with cyclic vomiting syndrome. The development of AKI could be attributed to intravascular volume depletion by persistent vomiting and dehydration, leading to reduced renal blood flow. Cannabis use disorder can lead to increase susceptibility to certain infections, which could contribute to increased rate of sepsis in these patients. It should pave the way for conducting further observational studies in order to assess the association of renal dysfunction and sepsis with cannabis use in patients with CVS. It should also create awareness among clinicians to keep AKI and sepsis as potential complications is such patients.

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