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Randomized Controlled Trial
. 2013 Jun;41(6):1518-25.
doi: 10.1097/CCM.0b013e318287f1bb.

Alcohol screening scores and 90-day outcomes in patients with acute lung injury

Brendan J Clark  1 , André Williams, Laura M Cecere Feemster, Katharine A Bradley, Madison Macht, Marc Moss, Ellen L Burnham; NHLBI ARDS Network Investigators
Affiliations
Randomized Controlled Trial

Alcohol screening scores and 90-day outcomes in patients with acute lung injury

Brendan J Clark et al. Crit Care Med. 2013 Jun.

Abstract

Objectives: The effects of excess alcohol consumption (alcohol misuse) on outcomes in patients with acute lung injury have been inconsistent, and there are no studies examining this association in the era of low tidal volume ventilation and a fluid conservative strategy. We sought to determine whether validated scores on the Alcohol Use Disorders Identification Test that correspond to past-year abstinence (zone 1), low-risk drinking (zone 2), mild to moderate alcohol misuse (zone 3), and severe alcohol misuse (zone 4) are associated with poor outcomes in patients with acute lung injury.

Design: Secondary analysis.

Setting: The Acute Respiratory Distress Syndrome Network, a consortium of 12 university centers (44 hospitals) dedicated to the conduct of multicenter clinical trials in patients with acute lung injury.

Subjects: Patients meeting consensus criteria for acute lung injury enrolled in one of three recent Acute Respiratory Distress Syndrome Network clinical trials.

Interventions: None.

Measurements and main results: Of 1,133 patients enrolled in one of three Acute Respiratory Distress Syndrome Network studies, 1,037 patients had an Alcohol Use Disorders Identification Test score available for analysis. Alcohol misuse was common with 70 (7%) of patients having Alcohol Use Disorders Identification Test scores in zone 3 and 129 (12%) patients in zone 4. There was a U-shaped association between validated Alcohol Use Disorders Identification Test zones and death or persistent hospitalization at 90 days (34% in zone 1, 26% in zone 2, 27% in zone 3, 36% in zone 4; p < 0.05 for comparison of zone 1 to zone 2 and zone 4 to zone 2). In a multiple logistic regression model, there was a significantly higher odds of death or persistent hospitalization in patients having Alcohol Use Disorders Identification Test zone 4 compared with those in zone 2 (adjusted odds ratio 1.70; 95% confidence interval 1.00, 2.87; p = 0.048).

Conclusions: Severe but not mild to moderate alcohol misuse is independently associated with an increased risk of death or persistent hospitalization at 90 days in acute lung injury patients.

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Figures

Figure 1
Figure 1
Data from the Albuerol Treatement for Acute Lung Injury (ALTA, Omega-3 Fatty Add/Antioxidant Supplementation Study (OMEGA), and Early versus Delayed Enteral Nutrition (EDEN) studies were combined to form a single database. *37 patients were enrolled in both the ALTA and OMEGA studies but are only induded in the ALTA portion of this flow diagram. **Includes patients enrolled through March 14, 2011. All patients listed as being enrolled in the OMEGA portion of this diagram were co-enrolled in the EDEN study.
Figure 2
Figure 2
Unadjusted rates of death or persistent hospitalization at 90 days in AUDIT zones 1-4. *p < 0.05 for comparison with zone 2.
Figure 3
Figure 3
Univariate comparison of ventilator and ICU free days in AUDIT zones 1-4. See table 1 for a definition of the AUDIT zones. *p <0.05 when compared to Zone 2.
See this image and copyright information in PMC

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