Acute Alcohol Intoxication and Long-Term Outcome in Patients with Traumatic Brain Injury

Abstract

The effect of blood alcohol concentration (BAC) on outcome after traumatic brain injury (TBI) is controversial. We sought to assess the independent effect of positive BAC on long-term outcome in patients with TBI treated in the intensive care unit (ICU). We performed a retrospective analysis of 405 patients with TBI, admitted to the ICU of a large urban Level 1 trauma center between January 2009 and December 2012. Outcome was six-month mortality and unfavorable neurological outcome (defined as a Glasgow Outcome Scale score of 1 [death], 2, [vegetative state], or 3 [severe disability]). Patients were categorized by admission BAC into: no BAC (0.0&; n = 99), low BAC ( < 2.3&; n = 140) and high BAC ( ‡ 2.3&; n = 166). Logistic regression analysis, adjusting for baseline risk and severity of illness, was used to assess the independent effect of BAC on outcome (using the no BAC group as the reference). Overall six-month mortality was 25% and unfavorable outcome was 46%. Multivariate analysis showed low BAC to independently reduce risk of sixmonth mortality compared with no BAC (low BAC adjusted odds ratio [AOR] 0.41, 95% confidence interval [CI] 0.19-0.88, p = 0.021) and high BAC (AOR 0.58, 95% CI 0.29-1.15, p = 0.120). Furthermore, a trend towards reduced risk of six-month unfavorable neurological outcome for patients with positive BAC, compared to patients with negative BAC, was noted, although this did not reach statistical significance (low BAC AOR 0.65, 95% CI 0.34-1.22, p = 0.178, and high BAC AOR 0.59, 95% CI 0.32-1.09, p = 0.089). In conclusion, low admission BAC ( < 2.3&) was found to independently reduce risk of six-month mortality for patients with TBI, and a trend towards improved long-term neurological outcome was found for BAC-positive patients. The role of alcohol as a neuroprotective agent warrants further studies.

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

“…Eighteen observational studies containing a total of 48,537 (37%) patients with positive BAC and 82,487 (63%) patients with negative BAC were ultimately included, and the mortality rates were analyzed in this meta‐analysis (Alexander et al., ; Berry et al., , ; Brennan et al., ; Chamoun et al., ; Chen et al., ; Gururaj, ; Hsieh et al., ; Levy et al., ; Lin et al., ; Lustenberger et al., ; Pandit et al., ; Raj et al., ; Salim et al., ,; Shandro et al., ; Tien et al., ). The overall mortality rate, the mortality rate of BAC‐positive subjects, and the mortality rate of BAC‐negative subjects, all with TBI, were 13.2%, 12.4%, and 13.7%, respectively.…”

Pharmacologic Neuroprotection for Functional Outcomes After Traumatic Brain Injury: A Systematic Review of the Clinical Literature

“…In the first study [65], 405 patients were retrospectively grouped according to blood alcohol concentration (BAC) on hospital admission after TBI: no BAC ( n = 99), low BAC (<2.3 %, n = 140), and high BAC (>2.3 %, n = 166). The primary outcome measures included 6-month mortality and unfavorable neurological outcome (GOS 1–3).…”

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

“…18,31,34 However, a recent study found low BAC levels also to significantly decrease risk of 6-month mortality. 36 Third, we could not assess the effect of different levels of BAC on outcome.…”