• Amy W Johnson, Lilian Golzarri Arroyo, Neetu Mahendraker, Jack Hosty, and Kurt Kroenke.
• Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), Indianapolis. Electronic address: aj94@iu.edu.
• J Pain Symptom Manage. 2023 Apr 1; 65 (4): 326334.e2326-334.e2.

ContextPatients with end-stage liver disease (ESLD) commonly experience pain and other symptoms that result in a poor quality of life. Few studies have examined opioid usage, adverse events (AEs), and other outcomes in ESLD patients receiving opioid analgesia.ObjectivesThis study aimed to compare outcomes in ESLD patients who received opioids to those who did not and to determine risk factors for AEs.MethodsThis was a retrospective case-cohort study of 270 hospitalized patients with ESLD that used administrative and clinical data from the electronic medical record.ResultsTwo-thirds of patients with ESLD admitted during the study period received at least one opioid analgesic. Patients who received opioids presented with a greater number of liver related complications and higher rates of anxiety (32% vs. 17%, P= 0.007), had substantially worse initial and average pain scores (both P< 0.001), and received more palliative care consultations. The opioid group had somewhat more respiratory (22.2% vs. 11.1%, P= 0.02) and gastrointestinal (38.5% vs. 25.2%, P= 0.03) AEs, but no increase in CNS adverse events which included hepatic encephalopathy. Anxiety and disease severity (i.e., the number of liver related complications) but not opioid administration were risk factors for the number of AEs.ConclusionOpioid administration was not an independent risk factor for the number of AEs in hospitalized patients with ESLD, whereas anxiety and more liver-related complications increased AE risk. Our findings suggest that opioids have an appropriate and reasonably safe role in alleviation of pain in patients with ESLD.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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