Association between COVID-19 and endocarditis in patients with cocaine or opioid use disorders in the United States

Incidence of new diagnoses of endocarditis in patients with and without opioid or cocaine use disorders from 2011 to 2022

The incidence of endocarditis in patients with OUD (measured in new cases per 1,000,000 people per day) increased from 3.7 in 2011 to 30.1 in 2022 (trend test, P.< 0.001). There was a period of stagnation from 2017 to 2020, which then accelerated during the COVID-19 pandemic. The incidence of endocarditis in CocaineUD patients followed a similar time trend as in OUD patients (trend test, P.< 0.001). The incidence of endocarditis in patients not using OUD or cocaine did not increase significantly between 2011 and 2022 (trend test, P.= 0.07) (Fig. 1). The incidence of endocarditis in a patient using OUD or cocaine UD was 3–8 times higher than in patients who did not, and endocarditis was critical for patients using opioids or cocaine. It indicates a health problem. The accelerated incidence of endocarditis during the pandemic compared to the pre-pandemic period suggests that COVID-19 infection may have further increased the risk of endocarditis in patients with OUD or cocaine UD suggests that

Incidence of endocarditis with or without opioid use disorder (OUD) or cocaine use disorder (CocaineUD) from 2011 to 2022 (measured as new cases per 1,000,000 people per day).

COVID-19 is associated with increased risk of new diagnoses of endocarditis in patients with cocaine use disorder and opioid use disorder

Next, by comparing propensity score-matched COVID-19(+) and COVID-19(-) cohorts, we found that COVID-19 was associated with an increased risk of new diagnoses of endocarditis in patients with OUD and CocaineUD. I checked to see if they were related. To investigate the association between COVID-19 and new diagnoses of endocarditis in patients with OUD, the study population included 49,331 people infected with COVID-19 between January 2020 and April 2022. It consisted of 455,290 OUD patients (the “COVID-19 (+) cohort”) and 405,959 who had no documented COVID-19 but had contact with a healthcare provider during the same period. Patients (“COVID-19 (-) cohort”). To investigate the association between COVID-19 and new diagnoses of endocarditis in CocaineUD patients, the study population included 23,687 people infected with COVID-19 between January 2020 and April 2022. It consisted of 216,022 CocaineUD patients (the “COVID-19 (+) cohort”) and 192,335 patients without documented COVID-19 but encountered in hospitals and clinics during the same period (the ” COVID-19 (-) cohort”). For OUD, the COVID-19(+) cohort was older, more female, and less likely to have adverse socioeconomic determinants of health, comorbidities, medications, medical procedures, and EHR-documented COVID-19 vaccination. Prevalence was higher than his COVID-19. (−) cohort.After matching propensity scores, the two cohorts were balanced (table 1). For CocaineUD, the COVID-19 (+) cohort had more adverse socioeconomic consequences of health, comorbidities, medications, medical procedures, and EHR-documented COVID-19 vaccination than the COVID-19 (-) cohort. The prevalence of determinants was high.After matching propensity scores, the two cohorts were balanced (table 2).

Among patients with OUD, the overall risk of new diagnosis of endocarditis was 1.18% in the COVID-19 (+) cohort, compared to 0.55% in the propensity score-matched COVID-19 (-) cohort. higher (HR: 2.23, 95% CI: 1.92–2.60).An increased risk was observed in his three patient groups by age (0–44, 45–64, ≥65) and in infective endocarditis (Fig. 2a). Among CocaineUD patients, the risk of new diagnosis of endocarditis was 1.14% in the COVID-19 (+) cohort, higher than 0.52% in the propensity score-matched COVID-19 (-) cohort ( HR: 2.24, 95% CI: 1.79–2.80).An increased risk was observed in his three patient groups by age (0–44, 45–64, ≥65) and in infective endocarditis (Fig. 2b).

a Comparison of 180-day risk of new diagnosis of endocarditis and infective endocarditis in all populations and in patients with OUD in three age groups (0–44, 45–64, ≥65). B. Comparison of 180-day risk of new diagnosis of endocarditis and infective endocarditis in patients with CocaineUD in all populations and three age groups (0-44, 45-64, ≥65). COVID-19(+) Cohort – Patients who contracted COVID-19 between 1 January 2020 and 18 April 2022, listed in his EHR in the TriNetX database. COVID-19 (−) Cohort – Persons with no record of COVID-19 who were encountered in hospitals and clinics between January 1, 2020 and April 18, 2022. COVID-19 (+) and COVID-19 (−) cohorts were analyzed for demographics (actual age, gender, race, ethnicity at index event), health, comorbidities, medical procedures, medications, and EHR Propensity scores were consistent for adverse socioeconomic determinants of – Documentation of vaccination status. Outcome (primary diagnosis of endocarditis or acute or subacute infective endocarditis) is based on index events (180 starting with his COVID-19 infection and recent medical encounter in the COVID-19(+) cohort). were tracked within a daily time window (COVID-19(−) cohort).

Impact of COVID-19 diagnosis, vaccination and hospitalization on 180-day risk of new-onset endocarditis in patients with COVID-19 and opioid or cocaine use disorders

Next, COVID-19 diagnostic criteria (clinical diagnosis and laboratory-confirmed cases only), vaccination (vaccine status documented in EHR), and hospitalization (within 2 weeks of COVID-19 onset) influences the risk of new infections. Diagnosis of endocarditis after COVID-19 infection in patients with OUD and CocaineUD. Among OUD patients, patients with a clinical diagnosis of COVID-19 (presence of ICD-10 code U07.1) were clinically confirmed but not laboratory-confirmed corresponding patients with COVID-19 had a significantly higher risk of endocarditis after COVID-19 than in Diagnosis (HR: 6.06, 95% CI: 3.86–9.50). Similar results were observed for CocaineUD (Figure 1). 3). These results suggest that a patient with a clinical diagnosis of COVID-19 was more likely to have her COVID-19 (e.g., COVID-19 symptom onset) more severely than a patient whose COVID-19 was confirmed by laboratory tests alone. suggests that it may have

“Clinical diagnosis” cohort – COVID-19 onset based on ICD-10 clinical diagnosis code U07.1. “Lab Test Only” Cohort – COVID-19 with confirmed COVID-19 based on lab test (code 9088). “EHR Recorded Vaccination” Cohort – Presence of COVID-19 vaccination in EHR. “No Vaccination Recorded in EHR” Cohort – No COVID-19 vaccination status in EHR. “Hospitalized” cohort – hospitalized within 2 weeks after COVID-19. ‘Not hospitalized’ cohort – not hospitalized within 2 weeks after COVID-19. Cohorts were propensity score-matched for demographics, adverse socioeconomic determinants of health, comorbidities, medications, and medical procedures.

Hospitalization within 2 weeks after COVID-19 infection was higher in OUD patients (HR: 4.85, 95% CI: 3.58–6.57) and CocaineUD patients (HR: 4.37, 95% CI: 2.91–6.56) (Fig. 3). The risk of a new diagnosis of endocarditis following COVID-19 did not differ between patients whose EHR documented his COVID-19 vaccination and those who did not (Fig. 3). Her COVID-19 unvaccinated patient, documented in the EHR, may have been vaccinated outside of a health care facility, so vaccination may have been associated with endocarditis in her COVID-19 patient. It cannot be concluded that the risk was not affected.

Gender, Racial, and Ethnic Differences in Risk of COVID-19-Related Endocarditis in Patients with Opioid or Cocaine Use Disorders

Among patients with both OUD and COVID-19, after propensity score matching for age, sex, socioeconomic determinants of health, comorbidities, medical procedures, and medications, we found an emerging incidence of post-COVID-19 endocarditis. There were significant racial and ethnic differences in diagnostic risk. Use and vaccination status documented in the EHR. The risk of a new diagnosis of endocarditis was lower in blacks than in whites (HR: 0.59, 95% CI: 0.43–0.80) and lower in Hispanics than in non-Hispanics (HR : 0.36, 95% CI: 0.22–). 0.60) (Fig. Four). No substantial gender differences were observed. There were significant racial and ethnic differences in the risk of new diagnoses of post-COVID-19 endocarditis between CocaineUD and COVID-19 patients. The risk of a new diagnosis of endocarditis was lower in blacks than in whites (HR: 0.59, 95% CI: 0.41–0.84) and lower in Hispanics than in non-Hispanics (HR : 0.38, 95% CI: 0.19–). 0.77) (Fig. Four).

Gender, race, and ethnicity cohorts tend to be consistent with other demographics, adverse socioeconomic determinants of health, comorbidities, medications, medical procedures, and COVID-19 vaccination status recorded in the EHR was the score.

180-day mortality and hospitalization risk after new diagnosis of endocarditis in patients with COVID-19 and opioid or cocaine use disorders

Among patients with opioid or cocaine use disorders, the 180-day hospitalization risk after new diagnosis of endocarditis was higher in patients with COVID-19 compared with 58.7% in matched patients without COVID-19. 67.5% (HR: 1.21, 95% CI: 1.07–1.35) (Figure 5A).The 180-day risk of death after a new diagnosis of endocarditis was 9.2% for patients with COVID-19 compared with 8.0% for patients without COVID-19 (HR: 1.16, 95% CI: 0.83–1.61) (Fig. 5B). Due to the small sample size, separate analyzes were not performed for opioid or cocaine use disorders.

a Kaplan-Meier curve of 180-day hospitalization risk after new diagnosis of endocarditis in patients with opioid or cocaine use disorders who had COVID-19 and those who did not have COVID-19. Health, comorbidities, medications, medical procedures, and COVID-19 vaccination status as recorded in the EHR. B. Kaplan-Meier curve of 180-day risk of death after new diagnosis of endocarditis in patients with opioid or cocaine use disorders who had COVID-19 versus those who did not have COVID-19, demographics, and harm after matching propensity scores for socioeconomic determinants of health, comorbidities, medications, medical procedures, and COVID-19 vaccination status recorded in the EHR.