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Association between blood alcohol concentration and mortality in critical illness

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. A study from Boston Massachusetts examined the association between BAC at hospital admission and risk of 30-day mortality in critically ill patients.

The study performed a 2-center observational study of patients treated in medical and surgical intensive care units in 2 teaching hospitals Boston, Massachusetts. The researchers studied 11,850 patients, 18 years or older, who received critical care between 1997 and 2007. The BAC determined in the first 24 hours of hospital admission was categorised as 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.

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 analysed 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.

The study results 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.

Source: Association between blood alcohol concentration and mortality in critical illness. Stehman CR, Moromizato T, McKane CK, Mogensen KM, Gibbons FK, Christopher KB. J Crit Care. 2015 Dec;30(6):1382-9.

 

 

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