Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Intensive Care, University of Tampere, Tampere University Hospital, Tampere, Finland.
Acta Anaesthesiol Scand. 2020 Feb;64(2):216-223. doi: 10.1111/aas.13484. Epub 2019 Oct 10.
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. Methods We conducted a retrospective analysis of clinical and laboratory data from a single ICU where %CDT and AUDIT-C were included in routine assessment. After excluding readmissions, 2532 adult patients from a 21-month period were included. Admission values of %CDT were available for 2049 patients, and AUDIT-C was available for 1617 patients. The association of %CDT and AUDIT-C with short- and long-term outcome was studied by using univariate and multivariate logistic regression analysis. Results %CDT was above the reference value in 23.7% (486/2048) of patients with available %CDT. Of patients with available AUDIT-C, 33% (544/1617) had a risk-level AUDIT-C score. Patients with a risk-level AUDIT-C score were significantly younger than those with a lower score (51 vs 64 years, P < .0001). Increased %CDT was associated with higher severity of illness. AUDIT-C was associated independently with increased risk of long-term mortality in multivariate analysis (P = .007). Conclusion One in three of ICU patients are risk-level alcohol users as measured with AUDIT-C score, and one in four are analysed with %CDT. The prevalence varies according to the method used and any method alone may be insufficient to detect risk-level consumption reliably. Editorial Comment Alcohol overconsumption is associated with need for ICU admission and with less favorable outcomes. Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
背景 研究表明，多达三分之一的重症监护病房（ICU）入院患者与酒精直接或间接相关。目前并未常规对酒精使用情况进行筛查。本研究旨在检测 ICU 入院患者中升高的 %CDT（糖蛋白缺乏转铁蛋白）和高于风险水平的 AUDIT-C（酒精使用障碍识别测试，摄入量）的患病率。
方法 我们对单 ICU 的临床和实验室数据进行了回顾性分析，其中 %CDT 和 AUDIT-C 纳入常规评估。排除再入院后，在 21 个月期间共纳入 2532 例成年患者。有 2049 例患者的 %CDT 入院值可用，1617 例患者的 AUDIT-C 可用。使用单变量和多变量逻辑回归分析研究了 %CDT 和 AUDIT-C 与短期和长期结局的关系。
结果 在有可用 %CDT 值的 2048 例患者中，有 23.7%（486/2048）的患者的 %CDT 值高于参考值。在有可用 AUDIT-C 值的 1617 例患者中，有 33%（544/1617）的患者 AUDIT-C 评分有风险。有风险评分的 AUDIT-C 患者显著比评分较低的患者年轻（51 岁 vs 64 岁，P<.0001）。升高的 %CDT 与疾病严重程度增加相关。多变量分析显示，AUDIT-C 与长期死亡率增加独立相关（P=.007）。
结论 按照 AUDIT-C 评分，三分之一的 ICU 患者为风险水平的酒精使用者，四分之一的患者通过 %CDT 进行分析。根据所使用的方法，患病率会有所不同，单独使用任何一种方法都可能无法可靠地检测到风险水平的饮酒。
编辑评论 酒精过度摄入与 ICU 入院和预后较差相关。尽管在筛查中灵敏度较低，但酒精过度摄入的诊断存在问题。在一项试点研究中，比较了一种生物标志物和一种筛查工具。研究结果表明，需要多种工具才能实现足够的灵敏度以进行检测。
