Methylnaltrexone's Effect on Cholestasis in Trauma Patients

Introduction Cholestasis in hospitalized patients receiving opiates has the potential to have devastating outcomes including acalculous cholecystitis, sepsis, or even death. In this study, we evaluate the outcomes of trauma patients treated with methylnaltrexone. Methods We conducted the study at Desert Regional Medical Center, a level 1 trauma center in Palm Springs, California. Our electronic medical record was queried for all trauma patients between January 1, 2018 and January 1, 2024. Patients were excluded if they were under 18 years old or had a documented history of cirrhosis, congestive heart failure, or cardiac arrest during their admission. Those not excluded were divided into a treatment group including those who received at least one dose of methylnaltrexone and those who never received a dose of methylnaltrexone. A control group was created matching by randomly selecting one patient from the non-treatment group for each patient in the treatment group. The control and treatment groups were then analyzed using SPSS (IBM Corp., Armonk, NY). Demographic data was compared using student t-test between the two groups including age, sex, length of stay, ICU length of stay, ventilator days, and mortality. A p-value is reported as a test statistic. The incidence of cholestasis was measured by either laboratory evidence of hyperbilirubinemia, radiologic evidence of cholecystitis, diagnosis code of cholecystitis, or procedural intervention for cholecystitis. The two groups were compared for incidence of cholestasis using student t-test. Results are reported below. Results A total of 9894 patients were evaluated for inclusion in the study. Of those patients, 1292 patients met the exclusion criteria, and 8602 patients were analyzed for administration of the study drug. Fifty-six patients received at least one dose of methylnaltrexone. The remaining 8597 patients did not receive the treatment. Fifty-six patients were selected randomly for the control group. The median age between the treatment and control groups did not show statistically significant differences. Sex was also not statistically different between the two groups with 38 males and 18 females in the treatment group as compared to 39 males and 17 females in the control group with a p-value of 0.86. The median hospital length of stay was longer in the treatment group at 13 days compared to only one day in the control group which was statistically different with a p-value of <.001. ICU length of stay was also found to be statistically different between the treatment and control groups with 4 and 0 days respectively and a p-value of <.001. Mortality between the two groups was also higher in the treatment group with five patients in the treatment group not surviving to discharge as compared to one patient in the control group (p-value = .044). Both groups had one patient who met the criteria for cholestasis representing an overall incidence of 1.8% for each group. Conclusion Our data suggests that patients who received the medication were overall sicker with longer hospital stays, increased mortality, and more likely to have required surgery. We did not show a significant difference in incident of cholestasis or acalculous cholecystitis between the two groups but suggest that a larger study is warranted to study a causal relationship.