Electronic poster

C.R. Stehman1, T. Moromizato2, C.K. McKane3, K.M. Mogensen4, F.K. Gibbons5, K.B. Christopher2
1Brigham and Women's Hospital, Departments of Emergency Medicine and Surgery, Boston, United States, 2Brigham and Women's Hospital, Renal Division, Boston, United States, 3Brigham and Women's Hospital, Department of Nursing, Boston, United States, 4Brigham and Women's Hospital, Department of Nutrition, Boston, United States, 5Massachusetts General Hospital, Pulmonary and Critical Care Medicine, Boston, United States
Paris 2013
INTRODUCTION. Biological data shows that acute alcohol administration improves experimental ischemia re-perfusion injury and subsequent organ dysfunction.
OBJECTIVES. In this study we hypothesized that the blood alcohol concentration (BAC) at hospital admission would decrease the risk of 30-day mortality in critically ill patients.
METHODS. We performed a two center observational study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. We studied 11,850 patients, age = 18 years, 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 < 10 mg/dL (below level of detection), 10-80 mg/dL, 80-160 mg/dL and > 160 mg/dL. The primary outcome was all cause mortality in the 30 days following hospital admission. Secondary outcomes included 90-day and 365-day mortality following hospital admission. 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 were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both BAC and mortality. Adjustment included age, gender, race (white, non-white), type (surgical versus medical), Deyo-Charlson index, and acute organ failure.
RESULTS. 30-day mortality of the cohort was 13.7%. Compared to patients with BAC levels < 10 mg/dL, patients with levels = 10 mg/dL had lower odds of 30-day mortality;
for BAC levels 10-79.9 mg/dL the OR was 0.53 (95%CI, 0.40-0.70),
for BAC levels 80-159.9 mg/dL it was 0.36 (95%CI, 0.26-0.49), and
for BAC levels = 160 mg/dL it was 0.35 (95%CI, 0.27-0.44).
Following multivariable adjustment, the OR (95%CI) of 30-day mortality was 0.93 (0.69-1.24), 0.74 (0.53-1.02), and 0.65 (0.50-0.83), in patients with BAC of 10-79.9 mg/dL, 80-159.9 mg/dL, = 160 mg/dL respectively compared to those with BAC < 10 mg/dL. Additional adjustment for sepsis, chronic liver disease, or trauma did not materially alter the point estimates.
When the cohort was analyzed with sepsis as the outcome of interest, the multivariable adjusted odds of sepsis in patients with BAC 80-160 mg/dL or >160 mg/dL were 0.72 (0.50-1.04) or 0.68 (0.51-0.90) respectively compared to those with BAC < 10 mg/dL. Further, in a subset of patients with blood cultures drawn (n=4,065), the multivariable adjusted odds of bloodstream infection in patients with BAC 80-160 mg/dL or > 160 mg/dL were 0.53 (0.27-1.01) or 0.49 (0.29-0.83) respectively compared to those with BAC < 10 mg/dL.
CONCLUSIONS. Analysis of 11,850 adult patients showed that having a detectable BAC at hospitalization was associated with significantly decreased odds of 30-day mortality following critical care. Further, BAC > 160 mg/dL at hospitalization is associated with significantly decreased odds of developing sepsis and bloodstream infection.
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