(887) Impact of Substance Use Disorders on Health Outcomes in Critically Ill Children With Sepsis

Introduction: The prevalence of substance use disorders (SUD) among children has increased over the years and is a high public health concern. Adult patients with a SUD history have increased hospitalization rates and complications. Whether these effects are also observed in pediatric patients is not well described. This study aims to determine if a history of SUD is associated with increased morbidity and the need for critical care resources in critically ill children with sepsis.

Methods: This was a retrospective cohort study, utilizing the TriNetX© electronic health record (EHR) database that included septic critically ill subjects aged 12 to 18. We determined SUD history through diagnostic codes before the index date and the study population was divided into two groups (SUD and no-SUD). Data related to demographics, International Classification of Diseases 10th edition diagnostic codes, procedural codes, and medication codes 7 days after the index date were collected. The primary outcomes measured were: organ dysfunction, usage of vasoactive/inotropic drugs, mechanical ventilation, and patient death within 365 days. Using multivariate logistic regression, the association of SUD history in critically ill patients and each outcome was tested while controlling for age, sex, race, social determinants of health (SDOH), and pediatric comorbidities.

Results: 5436 critically ill subjects with sepsis [730 (13.43) with SUD history and 4705 (86.57) with no-SUD history] were identified. In analyses adjusted for age, sex, race, SDOH, and pediatric comorbidities, history of SUD was associated with increased odds of organ dysfunction (adjusted odds ratio [aOR] 1.83; 95% confidence interval [CI] 1.55-2.17; p < 0.001), usage of vasoactive/inotropic drugs (aOR 1.23; 95% CI 1.04-1.46, p 0.02), and mechanical ventilation (aOR 2.18; 95% CI 1.84-2.59; p = < 0.001).

Conclusions: This retrospective analysis from a large nationwide EHR data suggests critically ill sepsis pediatric patients with a history of SUD are associated with increased utilization of critical care resources (usage of vasoactive/inotropic drugs and mechanical ventilation) and adverse health outcomes (organ dysfunction). Further study is needed to determine if substance abuse represents a potentially modifiable risk factor for critical illness in children.