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COVID-19 Further Raises Endocarditis Risk in People with Opioid, Cocaine Use Disorder
COVID-19 is associated with significantly increased risk for endocarditis in patients with opioid use disorder or cocaine use disorder, according to study results published online in Molecular Psychiatry.
“Drug-using populations, particularly those who use cocaine or opioids, have some of the highest risk for endocarditis,” wrote corresponding author Nora D. Volkow, MD, of the National Institute on Drug Abuse in Bethesda, Maryland, and coauthors, “and here we show that having a COVID-19 diagnoses further increases this risk.”
Dr Volkow and a team from Case Western Reserve University in Cleveland, Ohio, used electronic health record data to investigate links between COVID-19 in people with opioid or cocaine use disorders and a new diagnosis of endocarditis, a rare but often fatal inflammation of the heart valves. The study included 109 million patients from the United States. Among them, 736,502 had a diagnosis of opioid use disorder and 379,623 had a diagnosis of cocaine use disorder.
Between 2011 and 2022, the incidence rate of endocarditis in patients with opioid or cocaine use disorders significantly increased, according to the study. The steepest increase, however, occurred between 2021 and 2022.
Among patients with either substance use disorder, those who were clinically diagnosed with COVID-19 showed a higher risk for a new endocarditis diagnosis as well as for hospitalization compared with those with no COVID-19 diagnosis. Hazard ratios for endocarditis after COVID-19 were 2.23 for patients with opioid use disorder and 2.24 for patients with cocaine use disorder, the study found. The 180-day hospitalization risk following endocarditis was 67.5% in patients with COVID-19, compared to 58.7% in matched patients without COVID-19. Furthermore, the 180-day mortality risk after an endocarditis diagnosis was 9.2% in patients with COVID-19 compared with 8.0% in matched patients without COVID-19.
Black and Hispanic patients with opioid or cocaine use disorders showed a lower risk of COVID-19-associated endocarditis compared with non-Hispanic white patients with the substance use disorders, the study found. According to the authors, the finding is consistent with a higher rate of injection drug use in non-Hispanic white populations.
“The use of contaminated syringes or of injection practices in nonsterile setups increase the entry of bacteria into the blood stream that then circulates throughout the various organs and, in the endocardium, can result in endocarditis,” the authors wrote. “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.”
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