Burnham Ellen L, Pomponio Raymond, Perry Grace, Offner Patrick J, Ormesher Ryen, Peterson Ryan A, Jolley Sarah E
Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
Department of Medicine, Biostatistics and Informatics, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora CO.
CHEST Crit Care. 2024 Mar;2(1). doi: 10.1016/j.chstcc.2023.100045. Epub 2024 Jan 2.
Alcohol misuse is overlooked frequently in hospitalized patients, but is common among patients with pneumonia and acute hypoxic respiratory failure. Investigations in hospitalized patients rely heavily on self-report surveys or chart abstraction, which lack sensitivity. Therefore, our understanding of the prevalence of alcohol misuse before and during the COVID-19 pandemic is limited.
In critically ill patients with respiratory failure, did the proportion of patients with alcohol misuse, defined by the direct biomarker phosphatidylethanol, vary over a period including the COVID-19 pandemic?
Patients with acute hypoxic respiratory failure receiving mechanical ventilation were enrolled prospectively from 2015 through 2019 (before the pandemic) and from 2020 through 2022 (during the pandemic). Alcohol use data, including Alcohol Use Disorders Identification Test (AUDIT)-C scores, were collected from electronic health records, and phosphatidylethanol presence was assessed at ICU admission. The relationship between clinical variables and phosphatidylethanol values was examined using multivariable ordinal regression. Dichotomized phosphatidylethanol values (≥ 25 ng/mL) defining alcohol misuse were compared with AUDIT-C scores signifying misuse before and during the pandemic, and correlations between log-transformed phosphatidylethanol levels and AUDIT-C scores were evaluated and compared by era. Multiple imputation by chained equations was used to handle missing phosphatidylethanol data.
Compared with patients enrolled before the pandemic (n = 144), patients in the pandemic cohort (n = 92) included a substantially higher proportion with phosphatidylethanol-defined alcohol misuse (38% vs 90%; < .001). In adjusted models, absence of diabetes, positive results for COVID-19, and enrollment during the pandemic each were associated with higher phosphatidylethanol values. The correlation between health care worker-recorded AUDIT-C score and phosphatidylethanol level was significantly lower during the pandemic.
The higher prevalence of phosphatidylethanol-defined alcohol misuse during the pandemic suggests that alcohol consumption increased during this period, identifying alcohol misuse as a potential risk factor for severe COVID-19-associated respiratory failure. Results also suggest that AUDIT-C score may be less useful in characterizing alcohol consumption during high clinical capacity.
住院患者中的酒精滥用情况常常被忽视，但在肺炎和急性低氧性呼吸衰竭患者中很常见。对住院患者的调查严重依赖自我报告调查或病历摘要，缺乏敏感性。因此，我们对新冠疫情之前和期间酒精滥用患病率的了解有限。
在呼吸衰竭的重症患者中，由直接生物标志物磷脂酰乙醇定义的酒精滥用患者比例在包括新冠疫情在内的一段时间内是否有所变化？
前瞻性纳入2015年至2019年（疫情之前）和2020年至2022年（疫情期间）接受机械通气的急性低氧性呼吸衰竭患者。从电子健康记录中收集酒精使用数据，包括酒精使用障碍识别测试（AUDIT）-C评分，并在重症监护病房入院时评估磷脂酰乙醇的存在情况。使用多变量有序回归分析临床变量与磷脂酰乙醇值之间的关系。将定义酒精滥用的二分法磷脂酰乙醇值（≥25 ng/mL）与疫情之前和期间表示滥用的AUDIT-C评分进行比较，并按时间段评估和比较对数转换后的磷脂酰乙醇水平与AUDIT-C评分之间的相关性。采用链式方程多重填补法处理缺失的磷脂酰乙醇数据。
与疫情之前纳入的患者（n = 144）相比，疫情队列中的患者（n = 92）中磷脂酰乙醇定义的酒精滥用比例显著更高（38%对90%；P <.001）。在调整模型中，无糖尿病、新冠病毒检测呈阳性以及在疫情期间入组均与较高的磷脂酰乙醇值相关。疫情期间医护人员记录的AUDIT-C评分与磷脂酰乙醇水平之间的相关性显著降低。
疫情期间磷脂酰乙醇定义的酒精滥用患病率较高，表明在此期间酒精消费量增加，这表明酒精滥用是严重的新冠病毒相关呼吸衰竭的潜在危险因素。结果还表明，在临床负荷较高时，AUDIT-C评分在描述酒精消费情况方面可能不太有用。
