title: Impact of medical comorbidity and risk of death in 680 patients with alcohol use disorders.
abstract: BACKGROUND
  The association between alcohol use disorders and increased risk of mortality is well known; however, there have been few systematic evaluations of alcohol-related organ damage and its impact on survival in younger alcoholics. Therefore, we assessed medical comorbidity with a clinical index to identify subgroups of alcoholic patients at high risk of premature death.
  
  
  METHODS
  Hospital-based cohort of alcohol-dependent patients admitted for detoxification between 1999 and 2008 in Barcelona, Spain. At admission, sociodemographic characteristics and a history of alcohol dependence and abuse of illegal drugs were obtained through clinical interviews and questionnaires. Medical comorbidity was assessed with the Cumulative Illness Rating Scale (Substance Abuse) (CIRS-SA). Dates and causes of death were obtained from clinical records and death registers. Survival was analyzed using Kaplan-Meier methods, and Cox regression models were used to analyze the risk factors for premature death.
  
  
  RESULTS
  Median age of the patients (686 total, 79.7% men) was 43.5 years (interquartile range [IQR], 37.8 to 50.4), average alcohol consumption was 200 g/d (IQR, 120 to 280 g/d), and duration of alcohol use disorder was 18 years (IQR, 11 to 24). Medical comorbidity by CIRS-SA at admission showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%). After median follow-up of 3.1 years (IQR, 1.5 to 5.1), 78 (11.4%) patients died with a mortality rate of 3.28 × 100 person-years; according to Kaplan-Meier estimates, 50% (95% confidence interval [95% CI], 24 to 69%) of patients with severe medical comorbidity died in the first decade after treatment. In multivariate analysis, severe medical comorbidity (hazard ratio [HR], 5.5; 95% CI, 3.02 to 10.07) and being treated with methadone at admission (HR, 2.60; 95% CI, 1.50 to 4.51) were independent risk factors for premature death.
  
  
  CONCLUSIONS
  Systematic assessment of alcohol-related organ damage is relevant for the identification and treatment of those at increased risk of death.
authors: Municipal Centre for Substance Abuse Treatment (Centro Delta), IMSP Badalona, Badalona, Spain.
authors: Inmaculada
authors: I
authors: Rivas
authors: Arantza
authors: A
authors: Sanvisens
authors: Ferran
authors: F
authors: Bolao
authors: Daniel
authors: D
authors: Fuster
authors: Jordi
authors: J
authors: Tor
authors: Ramon
authors: R
authors: Pujol
authors: Marta
authors: M
authors: Torrens
authors: Celestino
authors: C
authors: Rey-Joly
authors: Robert
authors: R
authors: Muga
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends