Clinical Investigations

At-Risk Drinking Is Independently Associated With Acute Kidney Injury in Critically Ill Patients

Gacouin, Arnaud MD^1,2,3; Lesouhaitier, Mathieu MD^1,2; Frerou, Aurelien MD^1,2; Painvin, Benoit MD^1,2; Reizine, Florian MD^1,2; Rafi, Sonia MD^1,2; Maamar, Adel MD^1,2; Le Tulzo, Yves MD, PhD^1,2,3; Tadié, Jean Marc MD, PhD^1,2,3

Author Information

¹CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France.

²Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France.

³Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, F-35033 Rennes, France.

Dr. Gacouin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Gacouin and Tadié drafted the work. All authors contributed to the conception and design of the work, data acquisition, and analysis. All authors contributed to the interpretation of data for the work. All authors revised it critically for important intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 47(8):p 1041-1049, August 2019. | DOI: 10.1097/CCM.0000000000003801

Abstract

Objectives:

Unhealthy use of alcohol and acute kidney injury are major public health problems, but little is known about the impact of excessive alcohol consumption on kidney function in critically ill patients. We aimed to determine whether at-risk drinking is independently associated with acute kidney injury in the ICU and at ICU discharge.

Design:

Prospective observational cohort study.

Setting:

A 21-bed polyvalent ICU in a university hospital.

Patients:

A total of 1,107 adult patients admitted over a 30-month period who had an ICU stay of greater than or equal to 3 days and in whom alcohol consumption could be assessed.

Interventions:

None.

Measurements and Main Results:

We assessed Kidney Disease Improving Global Outcomes stages 2–3 acute kidney injury in 320 at-risk drinkers (29%) and 787 non–at-risk drinkers (71%) at admission to the ICU, within 4 days after admission and at ICU discharge. The proportion of patients with stages 2–3 acute kidney injury at admission to the ICU (42.5% vs 18%; p < 0.0001) was significantly higher in at-risk drinkers than in non–at-risk drinkers. Within 4 days and after adjustment on susceptible and predisposing factors for acute kidney injury was performed, at-risk drinking was significantly associated with acute kidney injury for the entire population (odds ratio, 2.15; 1.60–2.89; p < 0.0001) in the subgroup of 832 patients without stages 2–3 acute kidney injury at admission to the ICU (odds ratio, 1.44; 1.02–2.02; p = 0.04) and in the subgroup of 971 patients without known chronic kidney disease (odds ratio, 1.92; 1.41–2.61; p < 0.0001). Among survivors, 22% of at-risk drinkers and 9% of non–at-risk drinkers were discharged with stages 2–3 acute kidney injury (p < 0.001).

Conclusions:

Our results suggest that chronic and current alcohol misuse in critically ill patients is associated with kidney dysfunction. The systematic and accurate identification of patients with alcohol misuse may allow for the prevention of acute kidney injury.

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At-Risk Drinking Is Independently Associated With Acute Kidney Injury in Critically Ill Patients