Palliative Care

Journal Article Annotations
2023, 2nd Quarter

Palliative Care

Annotations by R Garrett Key, MD
July, 2023

  1. Hospital Opioid Usage and Adverse Events in Patients With End-Stage Liver Disease

PUBLICATION #1 — Palliative Care

Hospital Opioid Usage and Adverse Events in Patients With End-Stage Liver Disease
Amy W Johnson, Lilian Golzarri Arroyo, Neetu Mahendraker, Jack Hosty, Kurt Kroenke


The finding:
Opioid administration in patients hospitalized with end stage liver disease (ESLD) was not found to be associated with an increased rate of adverse events (AE), including CNS complications; the authors suggest that opioid analgesia is safe and appropriate for patients with ESLD and pain. However, anxiety and the number of liver-related complications were found to be associated with higher rates of AEs.

Strength and weaknesses:
The study included a relatively large cohort of 270 patients who were compared in a case-cohort design intended to allow for reasonable comparison between opioid treated and non-opioid exposed patients. The study was done at a single site and results may not be generalizable to other settings. The retrospective analysis makes it difficult to be certain of the indication for opioid use. Moreover, causality of adverse events is difficult to ascertain using this type of record review methodology.

C-L psychiatrists are often consulted to evaluate patients with ESLD who are also likely to have comorbid pain. Given the most common etiologies of ESLD—particularly alcohol use and chronic viral hepatitis—concerns about substance use and other psychiatric comorbidity are also common. There may be reluctance to employ opioids for the very common problem of pain in ESLD, and thus opioid analgesia may be unnecessarily withheld from people with ESLD. This review provides reasonable evidence that supports that opioid pharmacotherapy can be safely prescribed to help these vulnerable patients achieve a better quality of life.