Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis

Catherine J Choi; Stanley H Weiss; Umair M Nasir; Nikolaos T Pyrsopoulos

doi:10.4254/wjh.v12.i11.993

Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis

World J Hepatol. 2020 Nov 27;12(11):993-1003. doi: 10.4254/wjh.v12.i11.993.

Authors

Catherine J Choi¹, Stanley H Weiss², Umair M Nasir¹, Nikolaos T Pyrsopoulos³

Affiliations

¹ Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, United States.
² Department of Medicine, Biostatistics and Epidemiology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
³ Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07103, United States. pyrsopni@njms.rutgers.edu.

Abstract

Background: Recent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease (NAFLD). Cannabis use is associated with reduced risk for NAFLD, we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD.

Aim: To assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD.

Methods: We performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample (NIS) for hospitalizations of adults with a diagnosis of NAFLD. The NIS database is publicly available and the largest all-payer inpatient database in the United States. The patients with cannabis use were selected as cases and those without cannabis were selected as controls. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities. The liver-related outcomes such as portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were compared between the groups.

Results: A total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified. Of these, 3820 cases were selected as the cannabis group, and 7625 non-cannabis cases were matched as controls. Patients with cannabis use had a higher prevalence of ascites (4.5% vs 3.6%), with and without cannabis use, P = 0.03. The prevalence of portal hypertension (2.1% vs 2.2%), varices and variceal bleeding (1.3% vs 1.7%), and cirrhosis (3.7% vs 3.6%) was not different between the groups, with and without cannabis use, all P > 0.05. Hyperlipidemia, race/ethnicity other than White, Black, Asian, Pacific Islander or Native American, and higher comorbidity score were independent risk factors for ascites in the cannabis group. Among non-cannabis users, obesity and hyperlipidemia were independent protective factors against ascites while older age, Native American and higher comorbidity index were independent risk factors for ascites.

Conclusion: Cannabis was associated with higher rates of ascites, but there was no statistical difference in the prevalence of portal hypertension, varices and variceal bleeding, and cirrhosis.

Keywords: Cannabis; Fatty liver; Hospitalization; Liver diseases; Marijuana use; Nonalcoholic fatty liver disease.