Analysis of Patients with Alcohol Dependence Treated in Silesian Intensive Care Units

Analysis of patients with alcohol dependence (AD) treated in intensive care units has never been performed in Poland. Data from 25,416 adult patients identified in a Silesian Registry of Intensive Care Units were analysed. Patients with AD were identified, and their data were compared with the remaining population. Preadmission and admission variables that independently influenced ICU death in these patients were identified. Among 25,416 analysed patients, 2285 subjects (9.0%) were indicated to have AD among their comorbidities. Patients with AD were significantly younger (mean age: 53.3 ± 11.9 vs. 62.2 ± 15.5 years, p < 0.001) but had a higher mean APACHE II score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute pancreatitis, and severe metabolic abnormalities. ICU death and unfavourable outcomes were more frequent in these patients (47.8% vs. 43.0%, p < 0.001 and 54.1% vs. 47.0%, p < 0.001, respectively). Multiorgan failure as the primary cause of ICU admission was among the most prominent independent risk factors for ICU death in these patients (OR: 3.30, p < 0.001). Despite the younger age, ICU treatment of patients with AD was associated with higher mortality and a higher percentage of unfavourable outcomes.

Hazardous and harmful alcohol use in the Northern Territory, Australia: the impact of alcohol policy on critical care admissions using an extended sampling period

AIMS

To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia DESIGN, SETTING AND PARTICIPANTS: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single-centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use.

MEASUREMENTS

Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full-time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post-intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site.

FINDINGS

Overall, there was a 4.5% [95% confidence interval (CI) = 0.8-8.2%] absolute risk reduction between the time-periods (95% CI = 23.4 versus 18.9% for baseline and post-intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = -0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively).

CONCLUSIONS

Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use.

Prevalence and impact of hazardous alcohol use in intensive care cohort: A multicenter, register-based study

BACKGROUND

Reports of the prevalence and impact of hazardous alcohol use among intensive care unit (ICU) patients are contradictory. We aimed to study the prevalence of hazardous alcohol use among ICU patients and its association with ICU length of stay (LOS) and mortality.

METHODS

Finnish ICUs have been using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) to evaluate and record patients' alcohol use into the Finnish Intensive Care Consortium's Database (FICC). We retrieved data from the FICC from a 3-month period. We excluded data from centers with an AUDIT-C recording rate of less than 70% of admissions. We defined hazardous alcohol use as a score of 5 or more for women and 6 or more for men from a maximum score of 12 points.

RESULTS

Two thousand forty-five patients were treated in the 10 centers with an AUDIT-C recording rate of 70% or higher. AUDIT-C was available for 1576 (77%) patients and indicated hazardous alcohol use for 334 (21%) patients who were more often younger (median age 55 [interquartile range 42-65] vs 67 [57-74] [P < .001]) and male (78.1% vs 61.3% [P < .001]) compared to other patients. We found no difference in LOS or hospital mortality between hazardous and non-hazardous alcohol users. Among the non-abstinent, risk of death within a year increased with increasing AUDIT-C scores adjusted odds ratio 1.077 (95% confidence interval, 1.006-1.152) per point.

CONCLUSION

The prevalence of hazardous alcohol use in Finnish ICUs was 21%. Patients with hazardous alcohol use were more often younger and male compared with non-hazardous alcohol users.