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Association between blood alcohol concentration and mortality in critical illness.
J Crit Care. 2015 Dec; 30(6):1382-9.JC

Abstract

OBJECTIVE

In animal models of renal, intestinal, liver, cardiac, and cerebral ischemia, alcohol exposure is shown to reduce ischemia-reperfusion injury. Inpatient mortality of trauma patients is shown to be decreased in a dose-dependent fashion relative to blood alcohol concentration (BAC) at hospital admission. In this study, we examined the association between BAC at hospital admission and risk of 30-day mortality in critically ill patients.

DESIGN

We performed a 2-center observational study of patients treated in medical and surgical intensive care units in Boston, Massachusetts.

SETTING

Medical and surgical intensive care units in 2 teaching hospitals in Boston, Massachusetts.

PATIENTS

We studied 11850 patients, 18 years or older, who received critical care between 1997 and 2007. The exposure of interest was the BAC determined in the first 24 hours of hospital admission and categorized a priori as BAC less than 10 mg/dL (below level of detection), 10 to 80 mg/dL, 80 to 160 mg/dL, and greater than 160 mg/dL. The primary outcome was all-cause mortality in the 30 days after critical care initiation. Secondary outcomes included 90- and 365-day mortality after critical care initiation. Mortality was determined using the US Social Security Administration Death Master File, and 365-day follow-up was present in all cohort patients. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both BAC and mortality. Adjustment included age, sex, race (white or nonwhite), type (surgical vs medical), Deyo-Charlson index, sepsis, acute organ failure, trauma, and chronic liver disease.

RESULTS

Thirty-day mortality of the cohort was 13.7%. Compared to patients with BAC levels less than 10 mg/dL, patients with levels greater than or equal to 10 mg/dL had lower odds of 30-day mortality; for BAC levels 10 to 79.9 mg/dL, the OR was 0.53 (95% confidence interval [CI], 0.40-0.70); for BAC levels 80 to 159.9 mg/dL, it was 0.36 (95% CI, 0.26-0.49); and for BAC levels greater than or equal to 160 mg/dL, it was 0.35 (95% CI, 0.27-0.44). After multivariable adjustment, the OR of 30-day mortality was 0.97 (0.72-1.31), 0.79 (0.57-1.10), and 0.69 (0.54-0.90), respectively. When the cohort was analyzed with sepsis as the outcome of interest, the multivariable adjusted odds of sepsis in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.72 (0.50-1.04) or 0.68 (0.51-0.90), respectively, compared to those with BAC less than 10 mg/dL. In a subset of patients with blood cultures drawn (n=4065), the multivariable adjusted odds of bloodstream infection in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.53 (0.27-1.01) or 0.49 (0.29-0.83), respectively, compared to those with BAC less than 10 mg/dL.

CONCLUSIONS

Analysis of 11850 adult patients showed that having a detectable BAC at hospitalization was associated with significantly decreased odds of 30-day mortality after critical care. Furthermore, BAC greater than 160 mg/dL is associated with significantly decreased odds of developing sepsis and bloodstream infection.

Authors+Show Affiliations

Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.Department of Medicine, Okinawa Hokubu Prefectural Hospital, Okinawa, Japan.Department of Nursing, Brigham and Women's Hospital, Boston, MA.Department of Nutrition, Brigham and Women's Hospital, Boston, MA.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: kbchristopher@partners.org.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

26483354

Citation

Stehman, Christine R., et al. "Association Between Blood Alcohol Concentration and Mortality in Critical Illness." Journal of Critical Care, vol. 30, no. 6, 2015, pp. 1382-9.
Stehman CR, Moromizato T, McKane CK, et al. Association between blood alcohol concentration and mortality in critical illness. J Crit Care. 2015;30(6):1382-9.
Stehman, C. R., Moromizato, T., McKane, C. K., Mogensen, K. M., Gibbons, F. K., & Christopher, K. B. (2015). Association between blood alcohol concentration and mortality in critical illness. Journal of Critical Care, 30(6), 1382-9. https://doi.org/10.1016/j.jcrc.2015.08.023
Stehman CR, et al. Association Between Blood Alcohol Concentration and Mortality in Critical Illness. J Crit Care. 2015;30(6):1382-9. PubMed PMID: 26483354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between blood alcohol concentration and mortality in critical illness. AU - Stehman,Christine R, AU - Moromizato,Takuhiro, AU - McKane,Caitlin K, AU - Mogensen,Kris M, AU - Gibbons,Fiona K, AU - Christopher,Kenneth B, Y1 - 2015/09/02/ PY - 2015/02/22/received PY - 2015/06/02/revised PY - 2015/08/30/accepted PY - 2015/10/21/entrez PY - 2015/10/21/pubmed PY - 2016/8/9/medline KW - Alcohol KW - Critical care KW - Ethanol KW - Intensive care KW - Mortality KW - Sepsis SP - 1382 EP - 9 JF - Journal of critical care JO - J Crit Care VL - 30 IS - 6 N2 - OBJECTIVE: In animal models of renal, intestinal, liver, cardiac, and cerebral ischemia, alcohol exposure is shown to reduce ischemia-reperfusion injury. Inpatient mortality of trauma patients is shown to be decreased in a dose-dependent fashion relative to blood alcohol concentration (BAC) at hospital admission. In this study, we examined the association between BAC at hospital admission and risk of 30-day mortality in critically ill patients. DESIGN: We performed a 2-center observational study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. SETTING: Medical and surgical intensive care units in 2 teaching hospitals in Boston, Massachusetts. PATIENTS: We studied 11850 patients, 18 years or older, who received critical care between 1997 and 2007. The exposure of interest was the BAC determined in the first 24 hours of hospital admission and categorized a priori as BAC less than 10 mg/dL (below level of detection), 10 to 80 mg/dL, 80 to 160 mg/dL, and greater than 160 mg/dL. The primary outcome was all-cause mortality in the 30 days after critical care initiation. Secondary outcomes included 90- and 365-day mortality after critical care initiation. Mortality was determined using the US Social Security Administration Death Master File, and 365-day follow-up was present in all cohort patients. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both BAC and mortality. Adjustment included age, sex, race (white or nonwhite), type (surgical vs medical), Deyo-Charlson index, sepsis, acute organ failure, trauma, and chronic liver disease. RESULTS: Thirty-day mortality of the cohort was 13.7%. Compared to patients with BAC levels less than 10 mg/dL, patients with levels greater than or equal to 10 mg/dL had lower odds of 30-day mortality; for BAC levels 10 to 79.9 mg/dL, the OR was 0.53 (95% confidence interval [CI], 0.40-0.70); for BAC levels 80 to 159.9 mg/dL, it was 0.36 (95% CI, 0.26-0.49); and for BAC levels greater than or equal to 160 mg/dL, it was 0.35 (95% CI, 0.27-0.44). After multivariable adjustment, the OR of 30-day mortality was 0.97 (0.72-1.31), 0.79 (0.57-1.10), and 0.69 (0.54-0.90), respectively. When the cohort was analyzed with sepsis as the outcome of interest, the multivariable adjusted odds of sepsis in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.72 (0.50-1.04) or 0.68 (0.51-0.90), respectively, compared to those with BAC less than 10 mg/dL. In a subset of patients with blood cultures drawn (n=4065), the multivariable adjusted odds of bloodstream infection in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.53 (0.27-1.01) or 0.49 (0.29-0.83), respectively, compared to those with BAC less than 10 mg/dL. CONCLUSIONS: Analysis of 11850 adult patients showed that having a detectable BAC at hospitalization was associated with significantly decreased odds of 30-day mortality after critical care. Furthermore, BAC greater than 160 mg/dL is associated with significantly decreased odds of developing sepsis and bloodstream infection. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/26483354/Association_between_blood_alcohol_concentration_and_mortality_in_critical_illness_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(15)00458-X DB - PRIME DP - Unbound Medicine ER -