危重症非创伤患者的 ICU 入住率和一年死亡率与危险饮酒独立相关*。

At-risk drinking is independently associated with ICU and one-year mortality in critically ill nontrauma patients*.

机构信息

1CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France. 2Inserm-CIC-0203, Faculté de Médecine, Université Rennes I, IFRI 40, Rennes, France. 3Biosit, Faculté de Médecine, Université Rennes 1, Rennes, France.

出版信息

Crit Care Med. 2014 Apr;42(4):860-7. doi: 10.1097/CCM.0000000000000041.

DOI:10.1097/CCM.0000000000000041

PMID:24201172

Abstract

OBJECTIVES

The impact of at-risk drinking on the outcomes of nontrauma patients is not well characterized. The aim of this study was to determine whether at-risk drinking is independently associated with the survival of nontrauma patients in an ICU and within 1 year following ICU discharge.

DESIGN

Observational cohort study.

SETTING

A 21-bed mixed ICU in a university hospital.

PATIENTS

A total of 662 patients who experienced an ICU stay of 3 days or more and for whom alcohol consumption could be assessed.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

ICU-related variables were collected prospectively, and a 1-year follow-up was determined retrospectively. Analyses were adjusted based on prognostic determinants of short- and long-term outcomes, as previously described in ICU patients and alcohol abusers. Two hundred and eight patients (33%) were identified as at-risk drinkers according to the National Institute on Alcohol Abuse and Alcoholism criteria. Additionally, 111 patients (17%) died in the ICU, and 97 (15%) died after ICU discharge. From the ICU admission until the end of the 1-year follow-up period, the at-risk drinkers exhibited poorer survival than the non-at-risk drinkers (p = 0.0004, as determined by the log-rank test). More specifically, 50 at-risk drinkers (24%) versus 61 non-at-risk drinkers (13%) died in the ICU (p = 0.0009 for the comparison). After adjustment, at-risk drinking remained independently associated with mortality in the ICU (adjusted odds ratio of 1.83; 95% CI of 1.16-2.89; p = 0.01) and with mortality within the year following ICU discharge (adjusted hazard ratio of 1.70; 95% CI of 1.15-2.52; p = 0.008). The causes of death in the at-risk and non-at-risk drinkers were similar.

CONCLUSIONS

In this population of critically ill nontrauma patients, at-risk drinking was independently associated with death in the ICU and within the year following ICU discharge.

摘要

目的

高危饮酒对非创伤患者结局的影响尚未得到充分描述。本研究旨在确定高危饮酒是否与 ICU 中以及 ICU 出院后 1 年内非创伤患者的生存独立相关。

设计

观察性队列研究。

地点

一所大学医院的 21 张床位混合 ICU。

患者

共纳入 662 例 ICU 住院时间超过 3 天且可评估酒精摄入量的患者。

干预措施

无。

测量和主要结果

前瞻性收集 ICU 相关变量，并回顾性确定 1 年随访情况。分析基于 ICU 患者和酗酒者的短期和长期结局的预后决定因素进行调整。根据国家酒精滥用和酗酒研究所的标准，208 例（33%）患者被确定为高危饮酒者。此外，111 例（17%）患者在 ICU 内死亡，97 例（15%）患者在 ICU 出院后死亡。从 ICU 入院到 1 年随访结束，高危饮酒者的生存率低于非高危饮酒者（p=0.0004，对数秩检验）。具体而言，50 例高危饮酒者（24%）与 61 例非高危饮酒者（13%）在 ICU 内死亡（p=0.0009）。校正后，高危饮酒仍与 ICU 死亡率独立相关（校正优势比为 1.83；95%CI 为 1.16-2.89；p=0.01），与 ICU 出院后 1 年内死亡率相关（校正风险比为 1.70；95%CI 为 1.15-2.52；p=0.008）。高危饮酒者和非高危饮酒者的死亡原因相似。