University of California, Irvine, Department of Surgery, Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery, Orange, CA, USA.
University of California, Irvine, Department of Surgery, Division of Trauma, Burns, Surgical Critical Care and Acute Care Surgery, Orange, CA, USA.
Drug Alcohol Depend. 2021 Sep 1;226:108866. doi: 10.1016/j.drugalcdep.2021.108866. Epub 2021 Jun 25.
Improved survival in trauma patients with acute alcohol intoxication has been previously reported. The effect of illegal and controlled substances on mortality is less clear. We hypothesized that alcohol, illegal and controlled substances are each independently associated with lower odds of mortality in adult trauma patients.
The Trauma Quality Improvement Program (2010-2016) was queried for patients screening positive for alcohol, illegal or controlled substances on admission. A multivariate logistic regression analysis was used to determine odds of mortality. A similar analysis was used after stratification by injury severity scale (ISS).
From 1,299,705 adult patients, 660,135 were screened for substance use. Of these patients, 497,872 were male, 227,995 (34.5 %) screened positive for alcohol, 155,437 (23.5 %) for illegal substances and 90,259 (13.7 %) for controlled substances. Mortality rate was 6.2 % with alcohol, 5.1 % with illegal substances, and 5.7 % with controlled substances compared to 8.0 % with no substance use (p < 0.001). After controlling for covariates, all groups had lower odds of mortality: alcohol (OR = 0.88, CI = 0.84-0.92, p < 0.001), illegal substances (OR = 0.83, CI = 0.77-0.90, p < 0.001), controlled substances (OR = 0.72, CI = 0.67-0.79, p < 0.001). When stratified by ISS, alcohol and illegal substances continued to be associated with decreased mortality until ISS 50. Controlled substances were associated with decreased mortality when ISS > 16.
Patients positive for alcohol, illegal or controlled substances have 12 %, 17 %, and 28 % decreased odds of mortality, respectively. This paradoxical association should be confirmed with future clinical studies and merits basic science research to identify biochemical or physiological components conferring a protective effect on survival in trauma patients.
先前有报道称，创伤患者急性酒精中毒的存活率有所提高。非法和管制物质对死亡率的影响则不太明确。我们假设酒精、非法和管制物质各自与成年创伤患者的低死亡率相关。
我们查询了创伤质量改进计划（2010-2016 年）中入院时筛选出的酒精、非法或管制物质呈阳性的患者数据。我们使用多变量逻辑回归分析来确定死亡率的几率。我们还使用损伤严重程度评分（ISS）分层后进行了类似的分析。
从 1299705 名成年患者中，有 660135 名患者接受了药物使用筛查。其中，497872 名男性，227995 名（34.5%）筛查出酒精阳性，155437 名（23.5%）筛查出非法物质阳性，90259 名（13.7%）筛查出管制物质阳性。有酒精、非法物质和管制物质的患者死亡率分别为 6.2%、5.1%和 5.7%，而无物质使用的患者死亡率为 8.0%（p<0.001）。在控制了混杂因素后，所有组的死亡率都较低：酒精（OR=0.88，CI=0.84-0.92，p<0.001）、非法物质（OR=0.83，CI=0.77-0.90，p<0.001）、管制物质（OR=0.72，CI=0.67-0.79，p<0.001）。当按 ISS 分层时，酒精和非法物质与死亡率降低相关，直至 ISS 为 50。当 ISS>16 时，管制物质与死亡率降低相关。
酒精、非法或管制物质呈阳性的患者的死亡率分别降低了 12%、17%和 28%。这种矛盾的关联需要通过未来的临床研究来证实，并且值得进行基础科学研究以确定赋予创伤患者生存保护作用的生化或生理成分。
