Sasaki Kazuma, Tagami Takashi, Obinata Hirofumi, Tanaka Chie, Otake Kosuke, Yoshino Yudai, Watanabe Akihiro, Shibata Ami, Kuwamoto Kentaro, Inoue Junichi, Yokobori Shoji
Department of Emergency and Critical Care Medicine, Nippon Medical School Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki city, Kanagawa, 211-8533, Japan.
Crit Care. 2025 Mar 24;29(1):133. doi: 10.1186/s13054-025-05364-0.
The impact of alcohol on the prognosis of patients with traumatic brain injury (TBI) remains unclear. While some reports suggest that alcohol may exert neuroprotective effects, others indicate that it can worsen neurological outcomes. This study aimed to evaluate the influence of alcohol consumption on TBI outcomes using a nationwide database in Japan.
We analyzed data from approximately 290 hospitals contributing to the Japan Trauma Data Bank between 2004 and 2018. Patients with head injuries and documented pre-injury alcohol consumption were included. To adjust for potential confounders and institutional clustering, we employed propensity score methods-specifically inverse probability weighting (IPTW) and overlap weighting-and conducted multiple logistic regression with a generalized estimating equation. Covariates in the propensity score model included age, sex, day of the week, time of injury, period of injury, and past medical history. The primary outcome was in-hospital survival. Additionally, we fitted a multivariate logistic regression model (with survival as the outcome) to identify potential interactions and confounders. This model included type of trauma (blunt or penetrating), cause and setting of trauma, head Abbreviated Injury Scale score, multiple trauma status, the Injury Severity Score, and the propensity score.
Of the 83,789 patients who met the inclusion criteria, 15,752 had reported alcohol consumption prior to injury (alcohol group) and 68,037 did not (non-alcohol group). In-hospital survival was 91.5% in the alcohol group and 86.4% in the non-alcohol group (risk difference: 5.2%; 95% CI: 4.7-5.7). After adjustment, the alcohol group maintained a higher in-hospital survival rate (IPTW: 92.0% vs. 86.1%, risk difference: 6.2%; 95% CI: 5.9-6.2; overlap weighting: 91.7% vs. 85.4%, risk difference: 7.0%; 95% CI: 6.1-7.8). In the multivariate logistic regression, preinjury alcohol consumption was associated with higher survival (odds ratio: 1.58, 95% CI: 1.47-1.70, p < 0.001).
In this nationwide study, preinjury alcohol consumption was associated with higher in-hospital survival among patients with TBI. Further research is warranted to elucidate the underlying mechanisms and confirm these findings in more diverse populations.
酒精对创伤性脑损伤（TBI）患者预后的影响仍不明确。虽然一些报告表明酒精可能具有神经保护作用，但其他报告则指出它会使神经功能结果恶化。本研究旨在利用日本的全国性数据库评估饮酒对TBI结果的影响。
我们分析了2004年至2018年间向日本创伤数据库贡献数据的约290家医院的数据。纳入了有头部损伤且有受伤前饮酒记录的患者。为了调整潜在的混杂因素和机构聚类，我们采用了倾向评分方法——具体为逆概率加权（IPTW）和重叠加权——并使用广义估计方程进行多因素逻辑回归。倾向评分模型中的协变量包括年龄、性别、星期几、受伤时间、受伤时期和既往病史。主要结局是院内生存。此外，我们拟合了一个多因素逻辑回归模型（以生存作为结局）来识别潜在的相互作用和混杂因素。该模型包括创伤类型（钝性或穿透性）、创伤原因和环境、头部简明损伤量表评分、多发伤状态、损伤严重度评分和倾向评分。
在符合纳入标准的83,789例患者中，15,752例报告在受伤前饮酒（饮酒组），68,037例未饮酒（非饮酒组）。饮酒组的院内生存率为91.5%，非饮酒组为86.4%（风险差异：5.2%；95%置信区间：4.7 - 5.7）。调整后，饮酒组维持较高的院内生存率（IPTW：92.0%对86.1%，风险差异：6.2%；95%置信区间：5.9 - 6.2；重叠加权：91.7%对85.4%，风险差异：7.0%；95%置信区间：6.1 - 7.8）。在多因素逻辑回归中，受伤前饮酒与较高的生存率相关（比值比：1.58，95%置信区间：1.47 - 1.70，p < 0.001）。
在这项全国性研究中，受伤前饮酒与TBI患者较高的院内生存率相关。有必要进行进一步研究以阐明潜在机制，并在更多样化的人群中证实这些发现。
