Impact of Alcohol Misuse on Requirements for Critical Care Services and Development of Hospital Delirium in Patients With COVID-19 pneumonia

Abstract

Alcohol misuse has been associated with increased morbidity in the setting of pulmonary infections, including the need for critical care resource utilization and development of delirium. How alcohol misuse impacts morbidity and outcomes among patients admitted with COVID-19 pneumonia is not well described. We sought to determine if alcohol misuse was associated with an increased need for critical care resources and development of delirium among patients hospitalized with COVID-19 pneumonia.

Design: Retrospective cohort study.

Setting: Twelve University of Colorado hospitals between March 2020 and April 2021.

Patients: Adults with a COVID-19 diagnosis.

Interventions: None.

Measurements and main results: The primary outcome was admission to the ICU. Secondary outcomes included need for mechanical ventilation, development of delirium, and in-hospital mortality. Alcohol misuse was defined by International Classification of Diseases, 10th Revision codes. Of 5,979 patients hospitalized with COVID-19, 26% required ICU admission and 15.4% required mechanical ventilation. Delirium developed in 4.5% and 10.5% died during hospitalization. Alcohol misuse was identified in 4%. In analyses adjusted for age, sex, body mass index, diabetes, and liver disease, alcohol misuse was associated with increased odds of ICU admission (adjusted odds ratio [aOR], 1.46; p < 0.01), mechanical ventilation (aOR, 1.43; p = 0.03), and delirium (aOR, 5.55; p < 0.01) compared with patients without misuse. Mortality rates were not associated with alcohol misuse alone, although the presence of both alcohol misuse and in-hospital delirium significantly increased odds of in-hospital death (aOR, 2.60; p = 0.04).

Conclusions: Among patients hospitalized with COVID-19, alcohol misuse was associated with increased utilization of critical care resources including ICU admission and mechanical ventilation. Delirium was an important modifiable risk factor associated with worse outcomes in hospitalized patients with alcohol misuse, including increased odds of death.

Keywords: alcohol use disorder; intensive care; mechanical ventilation.

Figure 1.

Cohort derivation from the Health Data Compass (HDC) datamart. Participants were excluded from the study if the admission was not their first encounter for COVID-19, if they were pregnant, or if there were missing weight/body mass index (BMI) data. A total of 5,979 patients were included in the final cohort. ETOH = alcohol misuse present, R2D2 = Reliable Response Data Discovery for COVID-19 Consortium.

Figure 2.

Forest plot illustrating model of alcohol misuse and delirium interaction on the odds of in-hospital death. BMI = body mass index, CCI = Charlson Comorbidity Index, DM = diabetes mellitus, ETOH = alcohol misuse present, OR = odds ratio, REF = reference.