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Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients.
Crit Care Med. 2007 Feb; 35(2):345-50.CC

Abstract

OBJECTIVE

To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients.

DESIGN

Retrospective cohort study.

SETTING

Two ICUs in an urban hospital.

PATIENTS

Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >or=1 ICU day.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of first admissions appearing in the data set (n=9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p<.001), organ failure (67.3% vs. 45.8%, p<.001), septic shock (3.6% vs. 2.1%, p=.001), and hospital mortality (9.4% vs. 7.5%, p=.022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence.

CONCLUSIONS

Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association.

Authors+Show Affiliations

Ohio State University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Public Health, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17205003

Citation

O'Brien, James M., et al. "Alcohol Dependence Is Independently Associated With Sepsis, Septic Shock, and Hospital Mortality Among Adult Intensive Care Unit Patients." Critical Care Medicine, vol. 35, no. 2, 2007, pp. 345-50.
O'Brien JM, Lu B, Ali NA, et al. Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med. 2007;35(2):345-50.
O'Brien, J. M., Lu, B., Ali, N. A., Martin, G. S., Aberegg, S. K., Marsh, C. B., Lemeshow, S., & Douglas, I. S. (2007). Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Critical Care Medicine, 35(2), 345-50.
O'Brien JM, et al. Alcohol Dependence Is Independently Associated With Sepsis, Septic Shock, and Hospital Mortality Among Adult Intensive Care Unit Patients. Crit Care Med. 2007;35(2):345-50. PubMed PMID: 17205003.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. AU - O'Brien,James M,Jr AU - Lu,Bo, AU - Ali,Naeem A, AU - Martin,Greg S, AU - Aberegg,Scott K, AU - Marsh,Clay B, AU - Lemeshow,Stanley, AU - Douglas,Ivor S, PY - 2007/1/6/pubmed PY - 2007/3/21/medline PY - 2007/1/6/entrez SP - 345 EP - 50 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 2 N2 - OBJECTIVE: To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients. DESIGN: Retrospective cohort study. SETTING: Two ICUs in an urban hospital. PATIENTS: Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >or=1 ICU day. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of first admissions appearing in the data set (n=9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p<.001), organ failure (67.3% vs. 45.8%, p<.001), septic shock (3.6% vs. 2.1%, p=.001), and hospital mortality (9.4% vs. 7.5%, p=.022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence. CONCLUSIONS: Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17205003/Alcohol_dependence_is_independently_associated_with_sepsis_septic_shock_and_hospital_mortality_among_adult_intensive_care_unit_patients_ L2 - https://dx.doi.org/10.1097/01.CCM.0000254340.91644.B2 DB - PRIME DP - Unbound Medicine ER -