Unmasking the Burden of Cannabis in Cirrhosis: A Propensity-Matched Real-World Analysis.

INTRODUCTION: Cannabis use is increasingly prevalent among patients with liver disease, its clinical impact on outcomes in cirrhosis remains unclear. This study evaluates the association between cannabis use disorder and clinical complications in patients with cirrhosis. METHODS: We conducted a retrospective study using the TriNetX network. Adults aged 18-89 years with cirrhosis were divided into two cohorts: those with cannabis use disorder(n = 46,347) and those without (n = 888,138). Propensity score matching (1:1) was performed using demographics and key laboratory values. The final matched sample consisted of 46,168 patients in each group.Outcomes were assessed over a 1-year follow-up and included all-cause mortality, critical care admission, respiratory complications, dyselectrolytemia, and hypoalbuminemia. RESULTS: Patients with cannabis use disorder had significantly higher odds of all-cause mortality (OR 1.086, 95% CI 1.052-1.121), critical care admission (OR 1.400, 95% CI 1.348-1.453), pneumonia (OR 1.212, 95% CI 1.158-1.268), pneumothorax (OR 1.160, 95% CI 1.041-1.293), and hypoalbuminemia (OR 1.074, 95% CI 1.035-1.114). Hyponatremia (OR 1.241, 95% CI 1.191-1.293), hyperkalemia (OR 1.102, 95% CI 1.053-1.154) and hypokalemia (OR 1.302, 95% CI 1.248-1.359) were more frequent in the cannabis group. Non-significant associations were noted for hemothorax (OR 1.074, 95% CI 0.922-1.251) and empyema (OR 0.945, 95% CI 0.805-1.109). CONCLUSION: These observational findings suggest that documented cannabis use disorder may identify a higher-risk subgroup among patients with cirrhosis, but they do not establish causality. Clinicians may consider evaluating cannabis use when conducting risk assessment and counseling. Further prospective research is needed to better define the mechanisms and long-term impact of cannabis in advanced liver disease.