title: Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
abstract: The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness.
  
  
  
  This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days.
  
  
  
  Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%-2.3%) for abstinent patients, 1.6% (95% CI: 1.3%-1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%-2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%-2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%-49%) in abstinent patients, 44% (42%-45%) in patients with lower-risk alcohol use, 42% (39%-45%) in patients with moderate alcohol misuse, and 55% (49%-60%) in patients with severe alcohol misuse.
  
  
  
  Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.
authors.affiliation: a Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado , Aurora , Colorado , USA.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.affiliation: b Center of Excellence for Substance Abuse Treatment and Education , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|c Health Services Research and Development , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: d Division of Cardiology, Department of Medicine, Denver VA Medical Center , Denver , Colorado , USA.|e Department of Medicine , Division of Cardiology, University of Colorado , Aurora , Colorado , USA.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: c Health Services Research and Development , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: c Health Services Research and Development , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Chavez
authors.affiliation: a Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado , Aurora , Colorado , USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.affiliation: b Center of Excellence for Substance Abuse Treatment and Education , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|c Health Services Research and Development , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA.|f Group Health Research Institute , Seattle , Washington , USA.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000175:diagnosis*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Alcohol abuse; alcohol consumption; alcohol-related disorders; health care utilization; intensive care units; patient readmission