Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock.
OBJECTIVE
Alcohol is one of the most commonly used drugs in the world and causes dysfunction in many vital organs. However, the effects of chronic alcohol abuse on acute lung injury and nonpulmonary organ dysfunction are relatively unexplored. The goal of this study was to determine the effects of chronic alcohol abuse on the incidence and severity of the acute respiratory distress syndrome and multiple organ dysfunction syndrome in patients with septic shock.


METHODS
Multicenter prospective epidemiologic study.


METHODS
Intensive care units of four university urban hospitals. PATIENTS A total of 220 critically ill patients with septic shock.


RESULTS
Thirty percent of the patients (66 of 220) were identified as having a history of chronic alcohol abuse based on a positive response to an alcohol screening questionnaire. The incidence of acute respiratory distress syndrome in patients with a positive history of chronic alcohol abuse was 70% (46 of 66), compared with 31% (47 of 154) in individuals without a history of chronic alcohol abuse (p < .001). After adjusting for differences in the source of infection, sex, age, chronic hepatic dysfunction, diabetes, severity of illness, nutritional status, and smoking status, the effects of chronic alcohol abuse on the incidence of acute respiratory distress syndrome remained significant (p < .001; odds ratio, 3.70; 95% confidence interval, 1.83-7.71). The effect of the source of infection (pulmonary vs. nonpulmonary) on the development of acute respiratory distress syndrome also remained significant in this multivariable analysis (p < .001; odds ratio, 3.68; 95% confidence interval, 1.95-7.18). Based on the highest daily Sequential Organ Failure Assessment score, patients with a history of chronic alcohol abuse had more severe nonpulmonary organ dysfunction when compared with nonalcoholics (9.42 +/- 3.89 vs. 8.05 +/- 4.10, p = .01). After adjusting for source of infection, sex, age, nutritional status, history of diabetes, and smoking status, the effects of chronic alcohol abuse on the incidence of nonpulmonary organ dysfunction also remained significant (p = .03; odds ratio, 2.07; 95% confidence interval, 1.09-3.97).


CONCLUSIONS
We conclude that chronic alcohol abuse is an independent risk factor for acute respiratory distress syndrome and increases the severity of nonpulmonary organ dysfunction in patients with septic shock.
Moss
Marc
M
Department of Medicine, Division of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, GA 30335, USA. marc_moss@emory.org
Parsons
Polly E
PE
Steinberg
Kenneth P
KP
Hudson
Leonard D
LD
Guidot
David M
DM
Burnham
Ellen L
EL
Eaton
Stephanie
S
Cotsonis
George A
GA
D018806:APACHE; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D000704:Analysis of Variance; D002908:Chronic Disease; D003120:Colorado / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D016638:Critical Illness; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications*; D013997:Time Factors; D014861:Washington / Q000453:epidemiology