title: Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients.
abstract: OBJECTIVE
  To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two ICUs in an urban hospital.
  
  
  METHODS
  Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >or=1 ICU day.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of first admissions appearing in the data set (n=9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p<.001), organ failure (67.3% vs. 45.8%, p<.001), septic shock (3.6% vs. 2.1%, p=.001), and hospital mortality (9.4% vs. 7.5%, p=.022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence.
  
  
  CONCLUSIONS
  Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association.
authors.affiliation: Ohio State University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Public Health, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Bo
authors.initials: B
authors.lastname: Lu
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Ali
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.forename: Scott K
authors.initials: SK
authors.lastname: Aberegg
authors.forename: Clay B
authors.initials: CB
authors.lastname: Marsh
authors.forename: Stanley
authors.initials: S
authors.lastname: Lemeshow
authors.forename: Ivor S
authors.initials: IS
authors.lastname: Douglas
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality*; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality*