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.
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.
1 Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO.
2 Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO.
3 Health Services Research & Development, VA Puget Sound Healthcare System, Seattle, WA.
4 Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
5 Group Health Research Institute, Seattle, WA.
Supported, in part, by National Institutes of Health (K24-HL-089223, R24-AA-019661-01A1) and National Institutes of Health contract N01 HR56167; VA HSR&D fellowship (TPM 61-037) to Dr. Cecere.
Dr. Clark and Moss received funding from the National Institutes of Health.
Dr. Clark received grant support from the National Heart and Lung Bloos Institute. Dr. Feemster received grant support and funding for research for this study from the VA HSR&D Fellowship. Dr. Burnham received travel support from NIH.
Dr. Williams consulted for the Division of Bioinformatics and Biostatistics, National Jewish Health, Denver, CO).
The remaining authors have disclosed that they do not have any potential conflicts of interest.
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