Acute Alcohol Exposure and Risk of Mortality of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Abstract

After traumatic brain injury (TBI), patients usually live with significant disability and socioeconomic burdens. Acute exposure to alcohol is considered a major risk factor for TBI. Numerous studies have examined whether alcohol exposure is related to the risk of mortality in patients with TBI, yet the results remain inconsistent. We performed a meta-analysis to assess whether acute alcohol exposure affects the mortality rate of TBI patients. We searched PubMed, EMBASE, and the Cochrane Library up to November 2015 for relevant studies. We screened studies based on their inclusion criteria and selected the studies that reported mortality rate, which included 18 observational studies. We used R to analyze the included data. An initial result showed that the presence of a positive blood alcohol concentration (BAC) had no significant relation with mortality rate (OR = 0.92, 95% CI = 0.83 to 1.01), but there was notable heterogeneity along with variable results according to sensitivity analysis. For the BAC-positive population, low BAC (1 to 100 mg/dl) carried a higher risk of mortality than moderate BAC (100 to 230 mg/dl) (OR = 1.40, 95% CI = 1.09 to 1.81), moderate and high BAC as a single category (>100 mg/dl) (OR = 1.57, 95% CI = 1.28 to 1.94), or high BAC (>230 mg/dl) (OR = 1.76, 95% CI = 1.34 to 2.30). However, moderate BAC did not increase the mortality risk when compared with high BAC (OR = 1.20, 95% CI = 0.89 to 1.63). Whether positive BAC at the time of admission after TBI reduces mortality rate compared with the rate under negative BAC remains unknown. In addition, low BAC (1 to 100 mg/dl) poses a risk of mortality compared with higher BAC. Further studies assessing the effect of alcohol between the BAC-positive group and the BAC-negative group are still needed.

Dosage of Alcohol, Cocaine and Marijuana in Patients with Moderate and Severe Traumatic Brain Trauma Attended at the Hospital of Clinics of the Federal University of Uberlândia

“…1 Other studies found positivity in 22.8% and 37% respectively. 9 10 Our values are similar to those found in these same bibliographic citations. 9 10 When comparing our data with those found by Faria (2008) 11 who observed a positive blood alcohol level of 39.3%, it can be inferred that under the conditions of the dry law, there is no significant difference.…”

“…9 10 Our values are similar to those found in these same bibliographic citations. 9 10 When comparing our data with those found by Faria (2008) 11 who observed a positive blood alcohol level of 39.3%, it can be inferred that under the conditions of the dry law, there is no significant difference. Our study was performed under Decree 6,489 of 19/06/2008, which in turn became Law 11,705, popularly known as the Dry Law, and other laws that prohibited the sale of alcohol due to the Covid-19 pandemic.…”

Alcohol intake before injury and functional and survival outcomes after traumatic brain injury: Pan-Asian trauma outcomes study (PATOS)

“…[ 29 ] Among TBI patients with positive blood alcohol concentration, the moderate to high concentration group showed lower in-hospital mortality than the lower concentration of alcohol group. [ 7 ] Animal studies have postulated a neuroprotective effect of alcohol, including less reduction of cerebral blood flow, more normal glucose metabolism, higher corticosterone values, and less impairment of motor and cognitive functions, which can be neuroprotective. [ 15 , 30 ] However, in experimental study of TBI and hemorrhagic shock porcine model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion.…”

“…[19] In addition, we categorized GCS (alert [15]. verbal [13][14], pain [9][10][11][12], and unresponsive [3][4][5][6][7][8]), [23] AIS (mild [1][2] and severe [3][4][5][6]), [24] and NISS (mild [1][2][3][4][5][6][7][8], moderate [9][10][11][12][13][14][15], severe [16][17][18][19][20][21][22][23][24], and very severe ). [25] In our analysis, we dealt with missing data using a multiple imputation approach for reducing the potential bias that might arise from listwise deletion of cases with missing values.…”

“…[ 6 ] Although alcohol intake is associated with a higher incidence of injury, the effects of alcohol intake on prognosis of TBI remain controversial. [ 7 ] Some animal and human studies have reported neuroprotective effects of alcohol for brain injury, [ 8 , 9 ] and in a rodent model, alcohol intake was associated with accentuated neuro-inflammatory changes resulting from TBI. [ 10 ] In addition, 2 meta-analyses have reported that alcohol has the beneficial effect of lowering mortality for TBI patients.…”