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Observational Study
. 2014 Jun;76(6):1447-55.
doi: 10.1097/TA.0000000000000238.

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Majid Afshar  1 , Gordon S Smith, Michael L Terrin, Matthew Barrett, Matthew E Lissauer, Sahar Mansoor, Jean Jeudy, Giora Netzer
Affiliations
Observational Study

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Majid Afshar et al. J Trauma Acute Care Surg. 2014 Jun.

Abstract

Background: Elevated blood alcohol content (BAC) is a risk factor for injury. Associations of BAC with adult respiratory distress syndrome (ARDS) have not been conclusively established.We evaluated the association of a BAC greater than 0 mg/dL with the intermediate outcomes, Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score, and their association with ARDS development.

Methods: This is an observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003, to October 31, 2011. Logistic regression was performed to assess the relationship between admission BAC, ISS, GCS score, and ARDS development within 5 days of admission.

Results: The case rate for ARDS was 5.5% (1,447). BAC greater than 0 mg/dL was associated with ARDS development in adjusted analysis (odds ratio, 1.50; 95% confidence interval [CI], 1.33-1.71; p < 0.001). High ISS (≥16) had a stronger association with ARDS development (odds ratio, 17.99; 95% CI, 15.51-20.86), as did low GCS score (≤8) (odds ratio, 8.77; 95% CI, 7.64-10.07; p < 0.001). Patients with low GCS score and high ISS had the most frequent ARDS (33.6%) and the highest case-fatality rate without ARDS (24.7%).

Conclusion: Elevated BAC is associated with ARDS development. In the analysis of alcohol exposure, ISS and GCS score occur after alcohol ingestion, making them intermediate outcomes. ISS and GCS score were strong predictors of ARDS and may be useful to identify at-risk patients. Elevated BAC may increase the frequency of the ARDS through influence on injury severity or independent molecular mechanisms, which can be discriminated only in experimental models.

Level of evidence: Epidemiologic study, level III.

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Conflict of interest statement

Conflict of Interest and Source of Funding: No conflicts of interest or other funding sources to disclose amongst the authors. Majid Afshar and Giora Netzer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1
Figure 1
CONSORT Diagram † 1441 cases of ARDS in patients with Injury Severity Scores ‡ 24,131 cases without ARDS in patients with Injury Severity Scores
Figure 2
Figure 2
A. Primary exposure of alcohol is temporally associated and occurs prior to injury which is an intermediate outcome prior to ARDS development. Alcohol may have a direct relationship with ARDS development also. B. Unadjusted analyses from Shock Trauma Registry showing association between the primary exposure blood alcohol content with the intermediate outcomes ISS and GCS. The question of direct association of BAC with ARDS development cannot be answered without the ability to control the risk factors independently of each other.
See this image and copyright information in PMC

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