title: Markers of inflammation and mortality in a cohort of patients with alcohol dependence.
abstract: Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38-50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120-265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels >4.5 mg/dL; and 365 (49.5%) had ferritin levels >200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8-6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.52, P < 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41-7.26; P < 0.01) and 3.39 (95% CI: 1.86-6.43; P < 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patients.
authors.affiliation: From the Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (DF, AS, PZ, JT, RM); Department of Internal Medicine, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain (FB); and Municipal Centre for Substance Abuse Treatment (Centro Delta), IMSP Badalona, Badalona, Spain (IR).
authors.forename: Daniel
authors.initials: D
authors.lastname: Fuster
authors.forename: Arantza
authors.initials: A
authors.lastname: Sanvisens
authors.forename: Ferran
authors.initials: F
authors.lastname: Bolao
authors.forename: Paola
authors.initials: P
authors.lastname: Zuluaga
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Rivas
authors.forename: Jordi
authors.initials: J
authors.lastname: Tor
authors.forename: Robert
authors.initials: R
authors.lastname: Muga
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000097:blood* / Q000401:mortality*; D000740:Anemia / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D015331:Cohort Studies; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008108:Liver Diseases, Alcoholic / Q000097:blood / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male
chemical_list: D005340:Fibrinogen; D005293:Ferritins