Blood alcohol content, injury severity, and adult respiratory distress syndrome

Abstract

Background Elevated blood alcohol content is a risk factor for injury. Associations of blood alcohol content with acute respiratory distress syndrome have not been conclusively established. We evaluated the association of a BAC >0 mg/dL with the intermediate outcomes, Injury Severity Score and Glasgow Coma Score, and their association with acute respiratory distress syndrome development. Methods Observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003 to October 31, 2011. Logistic regression was performed to assess the relationship between Admission blood alcohol content, Injury Severity Score, Glasgow Coma Score, and acute respiratory distress syndrome development within five days of admission. Results The case-rate for acute respiratory distress syndrome was 5.5% (1447). Blood alcohol content >0 mg/dL was associated with acute respiratory distress syndrome development in adjusted analysis (Odds Ratio 1.50; 95% Confidence Interval 1.33–1.71, p<0.001). High Injury Severity Score (≥16) had a stronger association with acute respiratory distress syndrome development (Odds Ratio 17.99; 95% Confidence Interval 15.51–20.86); as did low Glasgow Coma Score (≤8) (Odds Ratio 8.77; 95% Confidence Interval 7.64–10.07, p<0.001). Patients with low Glasgow Coma Score and high Injury Severity Score had the most frequent acute respiratory distress syndrome (33.6%) and the highest case fatality rate without acute respiratory distress syndrome (24.7%). Conclusions Elevated blood alcohol content is associated with acute respiratory distress syndrome development. In the analysis of alcohol exposure, Injury Severity Score and Glasgow Coma Score occur after alcohol ingestion, making them intermediate outcomes. Injury Severity Score and Glasgow Coma Score were strong predictors of acute respiratory distress syndrome and may be useful to identify at-risk patients. Elevated blood alcohol content may increase the frequency of the acute respiratory distress syndrome through influence on injury severity or independent molecular mechanisms which can be discriminated only in experimental models

Acute immunomodulatory effects of binge alcohol ingestion

“…Acute alcohol exposure was encountered in more than 30% of trauma patients and intoxication carried the highest risk for injury (Afshar et al, 2014; Gmel et al, 2006). In preclinical trauma studies, alcohol-induced vasodilation, diuresis, decreased cardiac output, impaired vasoreactivity, and depressed myocardial contractility negatively impacted resuscitation and worsened outcomes (Molina, Sulzer, & Whitaker, 2013).…”

“…In preclinical trauma studies, alcohol-induced vasodilation, diuresis, decreased cardiac output, impaired vasoreactivity, and depressed myocardial contractility negatively impacted resuscitation and worsened outcomes (Molina, Sulzer, & Whitaker, 2013). Alcohol-exposed trauma victims who survived their injuries were at increased risk for nosocomial infection and acute respiratory distress syndrome (Afshar et al, 2014; Gmel et al, 2006). Acute alcohol ingestion also decreased resistance to infection-related complications and increased risk for mortality in humans and animals with sepsis (Pruett et al, 2010; Shih et al, 2003).…”

Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

“…33 In contrast, observational studies have shown that an elevated BAC is associated with an increased susceptibility to pneumonia, infections 34 and the development of adult respiratory distress syndrome. 35 Therefore, by using propensity score matching to attenuate the confounding effects of various patient characteristics and associated injury severity, this study was designed to assess the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients in a Level I trauma centre in Southern Taiwan.…”

Acute Respiratory Distress Syndrome and Outcomes After Near-Hanging

“…The ARDS case rate after near-hanging in our cohort (9%) is similar to that of the general trauma population [38][39][40], and that of our institution [13]. Other pulmonary complications after near hanging include aspiration pneumonia [3; 41], chest injury [42], and respiratory distress [43].…”

“…For the assessment of ARDS development, the Berlin definition [10] was incorporated into a validated screening algorithm [11][12][13]. This algorithm was combined with administrative data for ventilator charges, in order to identify all mechanically ventilated patients at risk for ARDS.…”