Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2020; 12(11): 993-1003
Published online Nov 27, 2020. 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
Catherine J Choi, Stanley H Weiss, Umair M Nasir, Nikolaos T Pyrsopoulos
Catherine J Choi, Umair M Nasir, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, United States
Stanley H Weiss, Department of Medicine, Biostatistics and Epidemiology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Nikolaos T Pyrsopoulos, Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07103, United States
Author contributions: Choi CJ designed the study, acquired data, performed statistical analysis, drafted, and edited this manuscript; Weiss SH supervised the design and reviewed statistical analysis of the study and edited the manuscript; Nasir UM acquired data, and edited the draft; Pyrsopoulos NT designed and supervised the study, and edited the manuscript.
Institutional review board statement: The activities described in our study do not meet the regulatory definition of human subjects research, and therefore our study was deemed not requiring approval by Rutgers Institutional Review Board (IRB).
Conflict-of-interest statement: Dr. Pyrsopoulos is a recipient of research grants from Mallinckrodt, Valeant, Gilead, Bayer, Beigene, Genfit, Prometheus, Grifols, Intercept, Zydus, and Eisai. Dr. Pyrsopoulos also has served as a consultant for Bayer, and Eisai. The other authors have no potential conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos T Pyrsopoulos, FACP, MD, PhD, Director, Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, 185 S. Orange Avenue, MSB H-535, Newark, NJ 07103, United States. pyrsopni@njms.rutgers.edu
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: July 30, 2020
Revised: August 27, 2020
Accepted: October 23, 2020
Article in press: October 23, 2020
Published online: November 27, 2020
ARTICLE HIGHLIGHTS
Research background

The impact of cannabis on the progression of chronic liver diseases has been unclear in prior studies. Systemic reviews showed no association between the increased prevalence of hepatic fibrosis and cannabis use, but cannabis use was still associated with a reduced prevalence of nonalcoholic fatty liver disease.

Research motivation

Because of the modulatory effects of cannabis on risk factors for the development of nonalcoholic fatty liver disease (NAFLD), we wanted to measure the correlation between cannabis use and clinical outcomes related to chronic liver diseases. Without clear evidence between the cannabis use and progression of established NAFLD, it is critical for clinicians to educate the patients on the use of cannabis due to limited evidence on cannabinoid effects. Therefore, our study is motivated to alert clinicians of the possible relevance of ascertainment of cannabis use, which in turn might alter future routine assessments to further probe about cannabis use, especially in light of trends showing recent increases in use in the United States.

Research objectives

Our study aimed to assess the association between cannabis use and clinical liver-related outcomes among hospitalized patients with NAFLD.

Research methods

In our study, we performed a retrospective matched cohort study for hospitalized adult patients with NAFLD. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities to adjust for confounders. The liver-related complications including portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were measured and compared between two groups.

Research results

The cannabis group had a higher prevalence of ascites compared to patients with NAFLD who did not use cannabis. Obesity and hyperlipidemia were independent protective effects against ascites in the non-cannabis group.

Research conclusions

Cannabis use was associated with higher rates of ascites despite higher rates of metabolic risks in the non-cannabis group such as diabetes, hyperlipidemia, and obesity. This suggests that cannabis may not be a magic bullet for the management of NAFLD, and therefore judicious use of cannabis in advanced NAFLD is warranted.

Research perspectives

A large prospective study in which mode and dose of cannabis use would be warranted to further explore the effects of administration mode and dose of cannabis on the liver-related clinical complications.