Alcohol-impaired driving among adults-USA, 2014-2018

INTRODUCTION

Alcohol-impaired driving (AID) crashes accounted for 10 511 deaths in the USA in 2018, or 29% of all motor vehicle-related crash deaths. This study describes self-reported AID in the USA during 2014, 2016 and 2018 and determines AID-related demographic and behavioural characteristics.

METHODS

Data were from the nationally representative Behavioral Risk Factor Surveillance System. Adults were asked 'During the past 30 days, how many times have you driven when you have had perhaps too much to drink?' AID prevalence, episode counts and rates per 1000 population were estimated using annualised individual AID episodes and weighted survey population estimates. Results were stratified by characteristics including gender, binge drinking, seatbelt use and healthcare engagement.

RESULTS

Nationally, 1.7% of adults engaged in AID during the preceding 30 days in 2014, 2.1% in 2016 and 1.7% in 2018. Estimated annual number of AID episodes varied across year (2014: 111 million, 2016: 186 million, 2018: 147 million) and represented 3.7 million, 4.9 million and 4.0 million adults, respectively. Corresponding yearly episode rates (95% CIs) were 452 (412-492) in 2014, 741 (676-806) in 2016 and 574 (491-657) in 2018 per 1000 population. Among those reporting AID in 2018, 80% were men, 86% reported binge drinking, 47% did not always use seatbelts and 60% saw physicians for routine check-ups within the past year.

CONCLUSIONS

Although AID episodes declined from 2016 to 2018, AID was still prevalent and more common among men and those who binge drink. Most reporting AID received routine healthcare. Proven AID-reducing strategies exist.

Seat belt use among patients in motor vehicle collisions: Clinical and demographic factors

OBJECTIVE

Proper use of automobile seat belt in a motor vehicle crash is associated with reduced morbidity and mortality, shorter hospital stays, reduced resource utilization, and fewer missed work days. Seatbelt compliance nationwide is 86%. This study was undertaken to identify factors associated with noncompliance with seatbelt use among admitted patients following a motor vehicle crash.

METHODS

This study was a retrospective analysis of motor vehicle crashes at an Urban Level 1 Trauma Center. Eligible subjects included patients age 18 and over, who were admitted by the Trauma Service following a motor vehicle crash from January to December 2017.

RESULTS

Among 766 participants, the overall rate of seatbelt noncompliance was 32% (N = 245). Some participants met the legal limit of intoxication (80 mg/dl) (N = 119 patients; 22%). Drug use was high among this population, including THC (30%), opiates (29%), benzodiazepines (24%), cocaine (10%), and methamphetamine (10%). Patients who did not wear seat belts were more likely to be male (62.4% no seat belt vs. 51.8% seat belt), intoxicated (30.5% vs. 17.0%), screen positive for cocaine (18.2% vs. 4.7%), THC (37.7% vs. 24.2%), and methamphetamine (15.6% vs. 5.9%). We did not detect significant differences by seat belt use with respect to ethnicity, mode of arrival, day of week, opiate use, or benzodiazepine use.

CONCLUSIONS

In this study, 32% of patients in motor vehicle crashes were not compliant with seat belt use. Noncompliance with seat belt use was higher among patients who were male, younger age, intoxicated, or who had positive screens for cocaine, THC, or methamphetamine.

Alcohol's harms to others in Wales, United Kingdom: Nature, magnitude and associations with mental well-being

Aim

To explore the nature and magnitude of alcohol's harms to others (AHTOs), and associations with mental well-being.

Methods

Cross-sectional survey implemented amongst 891 randomly selected Welsh residents (aged 18+ years), via computer assisted telephone interviews. Questions established past 12-month experience of nine direct harms resulting from another person's alcohol consumption (e.g. violence) and five linked outcomes (e.g. concern for a child). The source (e.g. partner/stranger) and frequency of the AHTO were collected, and respondents' socio-demographics, drinking behaviours and mental well-being status.

Results

During the past 12 months, 43.5% of respondents had experienced at least one direct harm (45.5% at least one direct harm/linked outcome). In demographically adjusted analyses, the odds of experiencing any direct harm decreased sequentially as age group increased (Adjusted Odds Ratio [AORs]: 1.9 [age 65–74 years] - 4.2 [age 18–34 years]), and was higher amongst binge drinkers (AOR, 1.5, p < 0.05). Associations between age group and suffering the direct harms anxiety, disrupted sleep, feeling threatened, property damage and emotional neglect were found. Experience of feeling threatened was lower amongst females (AOR 0.6, p < 0.05). In demographically adjusted analyses, low mental well-being was higher amongst those who had suffered alcohol-related financial issues (AOR 2.2, p < 0.001), emotional neglect (AOR 2.3, p < 0.01) and property damage (AOR 2.2, p < 0.05).

Conclusion

AHTOs place a large, although unequal burden on adults in Wales. Individuals' drinking patterns are associated with experience of AHTOs. Critically, experience of some harms is associated with low mental well-being.

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The harms from alcohol extend from the drinker to those around them (i.e. alcohol's harms to others [AHTOs]).

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AHTOs place a large, although unequal burden on the Welsh adult population, with young people and binge drinkers most at-risk.

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Experience of some AHTOs is associated with low mental well-being.

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AHTOs should be a consideration in the development, targeting and evaluation of alcohol policy and prevention activity.

Differences between the sexes in motorcycle-related injuries and fatalities at a Taiwanese level I trauma center

Background

Female patients present with unique physiological and behavioral characteristics compared to male patients. The aim of this study was to investigate and compare the injury patterns, injury characteristics, and mortality of male and female patients hospitalized for treatment of motorcycle accident-related trauma in a level I trauma center.

Methods

Retrospective analysis of motorcycle-related injuries from the Trauma Registry System was performed to identify and compare 4028 male and 2919 female patients hospitalized for treatment between January 1, 2009 and December 31, 2013.

Results

The female patients were younger, less often drunken, more often wore helmets, were transported by emergency medical services, and arrived at the emergency department between 7 a.m. and 5 p.m. compared to male patients. Analysis of Abbreviated Injury Scale scores revealed that female patients sustained significantly higher rates of injuries to the extremities, but lower rates of injuries to the head/neck, face, and thorax than male patients did. Female patients had a significant lower Injury Severity Score (ISS) and adjusted odds ratio of in-hospital mortality (AOR 0.83, 95% CI: 0.83–0.86) after adjustment by ISS. However, the logistic regression analysis of propensity score-matched patients with adjusted confounders including helmet-wearing status and alcohol intoxication revealed that the gender did not significantly influence mortality (OR 0.82, 95% CI 0.47–1.43; p = 0.475), implying the an associated risky behaviors may attribute to the difference of odds of mortality between the male and female patients. In addition, a significantly fewer female patients were admitted to the intensive care unit (ICU), and female patients had a significantly shorter hospital and ICU length of stay.

Conclusion

Female motorcycle riders have different injury characteristics, lower ISS and in-hospital mortality, and present with a bodily injury pattern that differs from that of male motorcycle riders.

Level of evidence

Epidemiologic study, level III.

Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study

AIMS

To investigate convictions for driving under the influence (DUI) before, during and after opioid maintenance treatment (OMT) and to examine factors associated with convictions for DUI during treatment.

DESIGN, SETTING AND PARTICIPANTS

Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records using unique person identifiers. Patients were followed over a 9-year period, before, during and in periods out of opioid maintenance treatment.

MEASUREMENTS

Data were formal charges leading to convictions recorded during four different time-periods: 3 years prior to application, waiting-list, in-treatment and in periods out of treatment.

FINDINGS

During OMT, convictions for DUI were reduced by almost 40% compared with pre-application levels. The conviction rate for DUI for males in the pre-application period was 9.59 per 100 person-years (PY) and for females, 3.44 per 100 PY. During OMT, rates of DUI convictions were reduced to 5.97 per 100 PY among men and to 1.09 per 100 PY among women. However, when estimating the effect of OMT on convictions for DUI, the interaction between gender and exposure to OMT was not statistically significant. Patients who remained in continuous treatment had fewer convictions for DUI during treatment compared with patients in discontinuous treatment. Compared with patients having no road traffic convictions during the pre-application period, patients with two or more pre-application convictions for DUI had higher odds [odds ratio (OR) = 3.69 (2.30-5.93)] for further convictions for DUI during OMT.

CONCLUSION

In Norway, patients receiving opioid maintenance treatment (OMT) have reduced convictions for driving under the influence (DUI) compared with their pre-treatment levels. Being male and having a previous history of several convictions for DUI were found to be important risk factors for convictions for DUI during OMT.

Characteristics of alcohol-related injuries in adolescents visiting the emergency department

Alcohol is frequently a factor affecting emergency department patients, and alcohol consumption is more common among those who are injured. In Korea, the socioeconomic impact of alcohol has been enormous because of traditional permissive attitudes toward alcohol. Juvenile drinking has increased recently; consequently, an increase in alcohol-related injuries is likely in this population. Therefore, we compared the characteristics and severity of alcohol-related injuries in adolescents and adults. All injured patients seen at six EDs throughout 2007 were included. We obtained data from the 'Development of a model for an in-depth injury surveillance system based on the emergency department' surveillance. The proportion of adolescents who drank was 5.0%. No significant alcohol-related difference in injuries was found between male and female adolescents (P = 0.14), whereas in adults, being male was strongly related to alcohol consumption (P < 0.001). Among traffic accidents, motorcycle-related injuries were strongly associated with alcohol use in adolescents (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.09-5.83). Results also indicated that alcohol-related injuries in adolescents showed poor outcomes (OR 2.36, 95% CI 1.47-3.81) as compared with those in adults (OR 1.42, 95% CI 1.26-1.59). Preventive strategy on alcohol-related injuries in adolescents should focus on reducing motorcycle accidents.

Epidemiology of motor vehicle crashes in Utah

OBJECTIVES

This study describes the frequency and pattern of vehicle crashes and safety belt use in Utah; the proportion of vehicle crashes involving safety belt use, alcohol, and fatigue; and the influence these factors and others have on emergency room visits or hospital admissions and on the severity of the outcome.

METHODS

Data were obtained from the Utah Department of Transportation, Division of Traffic and Safety, from 1999 through 2005. Motor vehicle crash (MVC) data were linked to statewide hospital admission (inpatient) and emergency department (ED) records.

RESULTS

The trend in rates of crashes significantly decreased for both males and females, with rates of crashes involving alcohol decreasing for males but increasing for females and rates of crashes involving fatigue remaining constant for males and females over the study period. Drivers not wearing a safety belt or intoxicated or fatigued were significantly more likely to have contributed to the crash, visit the emergency room, be admitted to the hospital, and experience severe injury or death. Drivers in crashes who were intoxicated or fatigued were significantly less likely to be wearing a safety belt. When a safety belt was worn at the time of the crash, sitting in the front seat was safer than in the second or third seats, and sitting on the left side of the vehicle was safer than on the right side or in the middle. However, when a safety belt was not worn at the time of the crash, sitting in the front seat was more likely associated with injury or death than in the second or third seats or sitting in the middle seat.

CONCLUSION

Drivers in crashes who were intoxicated or fatigued were less likely to be wearing a safety belt and more likely to have contributed to the crash and experience serious injury or death. Severity of injury related to seat placement is moderated by safety belt use.

Can the blood alcohol concentration be a predictor for increased hospital complications in trauma patients involved in motor vehicle crashes?

The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes. Data for the study was collected by a retrospective review of the University of Wisconsin Hospital trauma registry between 1999 and 2007 using the National Trauma Registry of the American College of Surgeons (NTRACS). Of 3729 patients, 2210 (59%) had a negative BAC, 338 (9%) <100 mg/dL, 538 (14%) 100-199 mg/dL, and 643 (17%) >200 mg/dL. Forty-six percent of patients had one or more hospital related complications. The odds ratio (OR) for the occurrence of alcohol withdrawal in the three alcohol groups compared to the no alcohol group was 12.02 (CI 7.0-20.7), 16.81 (CI 10.4-27.2), and 30.96 (CI 19.5-49.2) as BAC increased with a clear dose response effect. While there were no significant differences in the frequency of the total hospital events following trauma across the four groups, rates of infections, coagulopathies, central nervous system events and renal complications were lower in the high BAC group. Prospective studies are needed to more precisely estimate the frequency of hospital complications in patients with alcohol use disorders and in persons intoxicated at the time of the motor vehicle accident. The study supports the use of routine BAC to predict patients at high risk for alcohol withdrawal and the early initiation of alcohol detoxification.

The relationship between alcohol consumption and injury in ED trauma patients

BACKGROUND

Alcohol-related injuries are significantly more serious than non-alcohol-related injuries. However, there have been few data on the relationship between alcohol consumption and injury in the Korea. This study was designed to determine the absence or presence of alcohol consumption at the time of injury and the relationship between the quantity of alcohol and the extent of injury.

MATERIALS AND METHODS

The study subjects consisted of trauma patients aged 15 years or older with the emergency department admission at 5 emergency medical centers. With the informed consent, patients were screened using the questionnaire and blood alcohol concentration. The subjects were divided into 2 groups according to the blood alcohol concentration level: the nonintoxicated and intoxicated groups. The demographic characteristics, cause of injury, injury severity, and length of hospitalization were compared between the 2 groups.

RESULTS

Of a total of 407 cases, there were 123 cases in the intoxicated group and 284 cases in the nonintoxicated group. As to the severity of injury, an Abbreviated Injury Scale was significantly higher in the head and face. Injury Severity Score was higher in intoxicated group with marginal statistical significance. There was no significant difference in the total length of hospitalization, but the length of intensive care unit admission was significantly longer in the intoxicated group than in the nonintoxicated group.

CONCLUSION

There may be no significant correlation between alcohol consumption and injury severity. However, injury severity may increase with increasing quantity of alcohol and be greater in head injuries.

The relation between the use of psychoactive substances and the severity of the injury in a group of crash-involved drivers admitted to a regional trauma center

OBJECTIVE

There is much evidence that driving under the influence of alcohol and/or drugs of abuse is related to an increased accident risk. A remaining question is whether the use of psychoactive substances is also related to clinically more severe accidents. The aim of this study is to explore the relationship between the use of psychoactive substances and the injury severity in a group of crash-involved drivers.

METHODS

The study group included all injured car drivers, admitted to the regional trauma center, in the period from May 2000 until August 2001. The outcome of interest was the severity of injury, measured by using the Injury Severity Score (ISS). The determinant was the presence of psychoactive substances in blood and urine samples. Psychoactive substances tested for were alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, methadone, opiates, and tricyclic antidepressants in blood and urine.

RESULTS

The number of injured car drivers included in this study was 106. Overall, 43% (46/106) of the drivers tested positive for at least one psychoactive substance. Comparison of the means of the log ISS suggests that there is no significant difference between drivers who tested positive for alcohol and/or drugs, compared to drivers tested negative.

CONCLUSION

The results of this study support the hypothesis that there is no clear association between use of psychoactive substances and the severity of crash-related injury.

Analysis of injury- and violence-related fatalities in the Ohio Medicaid population: identifying opportunities for prevention

BACKGROUND

To identify the leading causes of injury- and violence-related deaths in demographic subgroups of the population in Ohio, by Medicaid status.

METHODS

We used linked Ohio Medicaid and death certificate files, 1992 to 1998, and obtained the probability (p) of dying from a specific mechanism of injury--given death from injury--by Medicaid status, using multinomial multivariable logistic regression analysis. Probabilities were rank-ordered to identify the leading causes of death in each subgroup.

RESULTS

The leading cause of injury-related deaths was homicide among Medicaid decedents in the age groups 0 to 4, 15 to 24, and 25 to 44 (p = 0.283, 0.380, and 0.269, respectively), and motor vehicle crashes among nonMedicaid decedents aged 5 to 14, 15 to 24, 25 to 44, and 45 to 74 (p = 0.448, 0.462, 0.293, and 0.293, respectively). Accidental falls ranked first among the elderly (p = 0.593 and 0.414, respectively in Medicaid and nonMedicaid decedents). Suicide and accidental exposure to smoke, fire, and flames also ranked high among the leading causes of injury-related deaths in many population subgroups.

CONCLUSIONS

Findings from this study, pointing to the vulnerability of population subgroups to certain mechanisms of injury, can be used to formulate targeted prevention strategies.

Traffic safety in the U.S.: re-examining major opportunities

INTRODUCTION

This article examines five major road-safety risk factors: exceeding posted speed limits, not using safety belts, driving while intoxicated, nighttime driving, and young drivers.

METHOD

The importance of each of these factors is documented, known effective countermeasures (both policy and technology based) are discussed, and impediments to the implementation of these countermeasures in the United States are examined.

RESULTS

Based on current understanding of the five major risk factors, and of the available countermeasures, there appear to be a variety of opportunities to make substantial gains in road safety using existing knowledge. The limited implementation of a variety of known countermeasures therefore appears to be inconsistent with high-level, strategic goals to improve road safety. Consequently, a recommendation is made to comprehensively re-examine the balance between the countermeasures discussed in this article and economic, mobility, and privacy concerns. IMPACT ON PUBLIC SAFETY: Such a re-examination is likely to result in broad support for these countermeasures, with a consequent major improvement in road safety.

Effectiveness of Brief Interventions After Alcohol-Related Vehicular Injury: A Randomized Controlled Trial

BACKGROUND

Because 40% of motor vehicle fatalities in the United States are alcohol-related, interventions delivered by trauma clinicians targeted to reduce drinking are of particular importance to public health. The objective of this study was to test the effectiveness of hospital-based brief intervention strategies to reduce alcohol consumption and other health-related outcomes in the year after an alcohol-related vehicular injury. Brief interventions are clinically based strategies including assessment and direct feedback about drinking alcohol, goal setting, behavioral modification techniques, and the use of a self-help manual.

METHODS

The study was a randomized controlled trial of two types of brief intervention with a 12-month follow-up. Participants with alcohol-related vehicular injury who were admitted to Level I trauma centers were eligible for enrollment. Enrolled participants were randomized to a control, simple advice, or brief counseling condition. Primary outcome variables were alcohol consumption (standard drinks/month, binges/month), adverse driving events (driving citations, traffic crashes), and changes in health status (hospital and emergency department admissions).

RESULTS

The study enrolled 187 participants at baseline and retained 100 across 12 months. Participants had a significant decrease in alcohol consumption and traffic citations at 12 months as compared with baseline. Mean standard drinks/month declined from 56.80 (SD 63.89) at baseline to 32.10 (SD 53.20) at 12 months. Mean binges/month declined from 5.79 (SD 6.98) at baseline to 3.21 (SD 6.17) at 12 months. There were no differences in alcohol consumption, adverse driving events, or health status by condition.

CONCLUSIONS

Whether the reductions in alcohol consumption and traffic citations were a result of the crash, hospitalization for injury, screening for alcohol use, or combination of these factors is difficult to determine. Further work is needed to understand the mechanisms involved in reductions of health-related outcomes and the role of brief intervention in this population.

Seat position and the risk of serious thoracoabdominal injury in lateral motor vehicle crashes

CONTEXT

Previous studies have suggested that motor vehicle occupants seated on the near-side of a lateral impact have a higher proportion of thoracoabdominal injuries. However, due to limitations in previous studies, the true association between seat position, side of lateral impact, and thoracoabdominal injury is unclear.

OBJECTIVE

To assess the relationship between seat position (i.e., near-side, middle-seat, and far-side, regardless of row), side of lateral motor vehicle crash (MVC), and serious thoracoabdominal injury after adjusting for important crash factors.

DESIGN

National population-based cohort of adult subjects involved in MVCs and included in the National Automotive Sampling System Crashworthiness Data System database (NASS CDS) from 1995 to 2003.

PATIENTS

Occupants aged > or =16 years involved in MVCs where the highest external deformation of the vehicle was located on the right or left side (i.e., lateral).

MAIN OUTCOME MEASURE

Serious thoracic or abdominal injury, defined as an Abbreviated Injury Scale (AIS) > or =3 in the thoracic or abdominal body region.

RESULTS

Fifteen thousand, one hundred and sixty persons involved in primary lateral MVCs were represented in the NASS CDS database during the 9-year period. There were 1867 (2%) persons with serious thoracic injuries and 507 persons (0.5%) with serious abdominal injuries. In multivariable logistic regression models that adjusted for important crash factors and the NASS CDS sampling design, seat position was a strong effect modifier of the association between side of lateral impact and serious thoracic (p<0.0001) and abdominal (p=0.0009) injury, with the risk of serious thoracic and abdominal injury highest for occupants seated on the near-side of the crash. The mean probability of injury was higher for near-side and middle-seat occupants compared to far-side occupants, and the probability of thoracic injury was approximately four times higher than that of abdominal injury for all seat positions.

CONCLUSIONS

There is a strong, synergistic relationship between seat position and side of lateral MVC in assessing risk of serious thoracic and abdominal injury among adult occupants. The probability of serious thoracoabdominal injury increases with increasing proximity of seat position to side of the crash and the risk of thoracic injury is higher than abdominal injury for all seat positions.

Drug use and the severity of a traffic accident

Several studies have showed that driving under the influence of alcohol and/or certain illicit or medicinal drugs increases the risk of a (severe) crash. Data with respect to the question whether this also leads to a more severe accident are sparse. This study examines the relationship between the use of alcohol, illicit drugs and/or medicinal drugs and the severity of an accident within a group of drivers that were involved in a crash in The Netherlands. Blood samples of 993 drivers, collected in the period from October 1998 through September 1999, were linked to accident characteristics as available from the National Transport Research Centre. The outcome measure was the severity of the accident. An accident was considered severe when the accident had resulted in hospital admission or death. All the blood samples obtained after the accident were screened for the presence of alcohol, illicit drugs (opiates, amphetamines and amphetamine-like substances, cocaine and metabolites, methadone, cannabinoids) and medicinal drugs (benzodiazepines, barbiturates and tricyclic antidepressants). The strength of the associations between exposure to the different classes of alcohol/drugs/medicines and the severity of the accident was evaluated using logistic regression analysis and were expressed as odds ratios (OR), adjusted for age, gender, time of the day, day of the week and urban area. The most frequently detected drugs were cannabinoids, benzodiazepines and cocaine. Our results showed no clear association between the use of alcohol, illicit drug and/or medicinal drug use and the severity of the accident. Given the process of obtaining blood samples from drivers involved in accidents and the retrospective nature of the study, we cannot rule out the occurrence of selection bias. Therefore, our findings need further confirmation.

Drinking history and risk of fatal injury: comparison among specific injury causes

The effect of acute alcohol use on injury risk is well documented, but the relationship between drinking history and fatal injury has not been adequately studied. The authors performed a case-control analysis to explore the association between drinking history and specific causes of fatal injury. Cases (n=5549) were persons who died from injury, selected from the 1993 National Mortality Followback Survey (NMFS); controls (n=42,698) were a representative sample of the general population, selected from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Current drinkers comprised 59% of the cases compared with 44% of the controls. After adjustment for age, sex, race/ethnicity, education, marital status, employment, and drug use, the odds ratio (OR) of dying from drowning for current drinkers was 3.48 (95% confidence interval (CI)=1.94, 6.25), the highest among all causes of injury studied. The lowest adjusted odds ratio associated with current drinking was for falls (OR=1.38; 95% CI=1.05, 1.82). Being a current drinker increased the risk of dying from suicide more for females (OR=4.04; 95% CI=1.64, 9.93) than for males (OR=1.45; 95% CI=1.20, 1.74). The authors conclude that drinking history is associated with a significantly increased risk of all types of fatal injury.

Consequences of alcohol-induced early dysregulation of responses to trauma/hemorrhage

Acute alcohol intoxication is a frequent underlying condition associated with traumatic injury. Studies from our laboratory have been designed to examine the early hemodynamic, proinflammatory, and neuroendocrine alterations in responses to hemorrhagic shock in surgically catheterized, conscious, unrestrained, male Sprague-Dawley rats during acute alcohol intoxication (1.75-g/kg bolus, followed by a constant 15-h infusion at a rate of 250-300 mg/kg/h). With both fixed-pressure (40 mm Hg) and fixed-volume (50%) hemorrhagic shock, followed by fluid resuscitation with Ringer's lactate, acute (15 h) alcohol intoxication has been shown to impair significantly the immediate hemodynamic, metabolic, and inflammatory counterregulatory responses to hemorrhagic shock. Alcohol intoxication enhanced hemodynamic instability during blood loss and impaired the recovery of mean arterial blood pressure during fluid resuscitation. Activation of neuroendocrine pathways involved in restoring hemodynamic stability was significantly attenuated in alcohol-intoxicated hemorrhaged animals. The hemodynamic and neuroendocrine impairment is associated with enhanced expression of lung and spleen tumor necrosis factor, and it suppressed circulating neutrophil function. In addition, neuroimmune regulation of cytokine production by spleen-derived macrophages obtained from alcohol-intoxicated hemorrhaged animals was impaired when examined in vitro. We hypothesize that impaired neuroendocrine activation contributes to hemodynamic instability, which, in turn, prolongs tissue hypoperfusion and enhances risk for tissue injury. Specifically, the early dysregulation in counterregulatory responses is hypothesized to affect host defense mechanisms during the recovery period. We examined host response to systemic (cecal ligation and puncture) and localized (pneumonia) infectious challenge in animals recovering from hemorrhage during acute alcohol intoxication. Increased morbidity and mortality from infection were observed in alcohol-intoxicated hemorrhaged animals. Our results indicate that alcohol-induced alterations in early hemodynamic and neuroimmune responses to shock have an impact on susceptibility to an infectious challenge during the early recovery period.

INCREASED SUSCEPTIBILITY TO LIVER INJURY AFTER HEMORRHAGIC SHOCK IN RATS CHRONICALLY FED ETHANOL: ROLE OF NUCLEAR FACTOR-??B, INTERLEUKIN-6, AND GRANULOCYTE COLONY-STIMULATING FACTOR

Chronic ethanol use preceding severe trauma and hemorrhagic shock (HS) is associated with an increased incidence of multiorgan failure (MOF) and death; however, the molecular basis for this increased susceptibility is unknown. We previously demonstrated that production of interleukin-6 (IL-6) and granulocyte colony-stimulating factor (G-CSF), mediated by nuclear factor-kappa B (NF-kappa B), each make essential contributions to organ injury and inflammation in a rodent model of controlled HS, and we proposed in this study to examine the hypothesis that the increased susceptibility to MOF after shock/trauma in the setting of chronic ethanol use is due to an exaggerated activation of NF-kappa B and production of these proinflammatory cytokines. We observed increased HS-induced liver injury 4 h after resuscitation in rats fed the ethanol-containing Lieber-DeCarli liquid diet for 8 weeks compared with rats fed the control liquid diet (3-fold increase in serum alanine aminotransferase [ALT], P = 0.008, and 2-fold increase in focal liver necrosis, P = 0.005). The increased liver injury in the ethanol-fed HS rats was accompanied by a 70% increase in liver NF-kappa B activation (P < 0.05), a 3- to 5-fold increase in hepatocyte and Kupffer cell production of IL-6 and G-CSF (P < 0.05 for each), and a 2-fold increase in neutrophil infiltration (P < 0.005) compared with the control diet-fed HS rats. Thus, increased susceptibility to HS-induced liver injury in the setting of chronic ethanol use may be mediated, at least in part, by increased NF-kappa B activation resulting in increased local production of IL-6 and G-CSF and increased infiltration of neutrophils, which can damage liver cells directly and contribute to impaired sinusoidal blood flow.