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December 13, 2022
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COVID-19-associated endocarditis risk ‘substantial’ in those with cocaine, opioid use disorders

Fact checked byShenaz Bagha
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COVID-19 infection more than doubles risk for a new diagnosis of endocarditis in adults with cocaine or opioid use disorder, according to data published in Molecular Psychiatry.

People with substance use disorder already face major impediments to proper health care due to lack of access and stigma,” Nora D. Volkow, MD, director of the National Institute on Drug Abuse, said in a press release. “Proven techniques like syringe service programs, which help people avoid infection from reused or shared injection equipment, can help prevent this often fatal and costly condition.”

Source: Adobe Stock.
COVID-19 infection more than doubles risk for a new diagnosis of endocarditis in adults with cocaine or opioid use disorder.
Source: Adobe Stock

Assessing nationwide data

In a retrospective study, Volkow and colleagues assessed electronic health records from a nationwide database of 109 million patients from 77 hospitals in the U.S., including 736,502 patients with a diagnosis of opioid use disorder and 379,623 patients with a diagnosis of cocaine use disorder.

Researchers found the incidence rate of endocarditis among patients with opioid use disorder or cocaine use disorder increased from 2011 to 2022, with acceleration particularly during the pandemic period. In 2011, there were four cases of endocarditis per day for every 1 million people with opioid use disorder. In 2022, this rate increased to 30 cases per day per 1 million people with opioid use disorder. For people with cocaine use disorder, cases increased from five per 1 million people with cocaine use disorder in 2011 to 23 cases in 2022.

COVID-19 was associated with increased risk for a new diagnosis of endocarditis among patients with opioid use disorder (HR = 2.23; 95% CI, 1.92-2.6) and with cocaine use disorder (HR = 2.24; 95% CI, 1.79-2.8). Clinically diagnosed COVID-19 was associated with higher risk for endocarditis than lab-test confirmed COVID-19 without a clinical diagnosis. Hospitalization within 2 weeks following COVID-19 infection was associated with increased risk for a new diagnosis of endocarditis. EHR-recorded vaccination status did not affect risk; however, the researchers noted that most vaccinations likely occurred outside of health care organizations so this could not be accurately assessed.

Risk for hospitalization, death

Among patients with opioid use disorder or cocaine use disorder, the 180-day hospitalization risk after endocarditis was 67.5% in patients with COVID-19 and 58.7% in matched patients without COVID-19 (HR = 1.21; 95% CI, 1.07-1.35). The 180-day mortality risk after a new diagnosis of endocarditis was 9.2% in patients with COVID-19 and 8% in matched patients without COVID-19 (HR = 1.16; 95% CI, 0.83-1.61).

There were also differences in outcomes by race, with Volkow and colleagues observing lower risk for COVID-19-associated endocarditis in Black vs. white adults and among Hispanic vs. non-Hispanic adults.

“Though our data cannot inform the mechanisms by which COVID-19 increased the risk for endocarditis, we speculate that COVID-19 induced inflammation and vascular pathology rendered the endocardium more vulnerable to the risks associated with injection drug use or even with drug use itself,” the researchers wrote. “Indeed, both bacteremia and endothelial damage underlie endocarditis and the use of drugs like cocaine and opioids through their pharmacological effects can damage blood vessels.”

The researchers noted it is critical that clinicians continue to monitor long-term, broad impacts of COVID-19 on people who use drugs.

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