Impact of substance use disorders on critical care management and health outcomes in septic adolescents

Background Adult septic patients with substance abuse disorder (SUD) are at increased risk of poor outcomes, but the impact on adolescents is unknown. We aimed to determine if pre-existing SUD is associated with increased adverse outcomes and critical care resources in critically ill adolescents hospitalized with sepsis. We hypothesize that SUD is associated with increased risk of adverse outcomes and usage of critical care resources in this adolescent patient population. Methods This was a retrospective cohort study utilizing the TriNetX (c) electronic health record (EHR) database, which consists of EHR from participating healthcare organizations predominantly in the United States. Critically ill adolescents with sepsis aged 12-21 years were divided into two groups (SUD history and no-SUD history). Data related to demographics, diagnostic, procedural, and medication codes were analyzed. The primary outcomes were organ dysfunction, critical care therapies, and all-cause 1-year mortality. Results We included 5,436 critically ill adolescents with sepsis [730 (13.43%) SUD history and 4706 (86.57%) no-SUD history]. SUD history was associated with increased odds of organ dysfunction (adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.56-2.16; p < 0.001), vasoactive/inotropic drug usage (aOR 1.29; 95% CI 1.10-1.52; p = 0.002), mechanical ventilation (aOR 2.19; 95% CI 1.85-2.59; p < 0.001), but not mortality (aOR 1.03; 95% CI 0.76-1.41; p = 0.83). Conclusions Our retrospective analysis suggests history of SUD in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction. Further study is needed to determine if substance abuse represents a potentially modifiable risk factor for critical illness in adolescent patients. Key points It is unknown whether substance abuse is a potentially modifiable risk factor for critical illness in adolescent patients. The findings from this retrospective study suggests history of substance use disorder in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction. Thus, substance abuse may be a modifiable risk factor of adolescent health outcomes.