Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult ICU patients Crit Care Med 2007 ; 35 : Presented by R2 Yu Tae - Kyung Journal conference

Background alcohol dependence -> 9–39% of ICU pts -> critical illnesses ↑ (trauma, hypothermia, and pancreatitis) -> respiratory failure (acute alcohol intoxication, alcohol withdrawal syndrome)

Sepsis -> tenth leading cause of death in the US (mortality rates >30%) -> associated with extremes of age, male, nonwhite comorbidities (liver disease, HIV, cancer) therapeutic interventions (in-dwelling catheters) red cell transfusions

Chronic alcohol abusers -> increase predisposition to infection mediate an association with sepsis -> Increase the severity of pneumonia, risk of acute lung injury and the ARDS in some studies -> limited data of the association btween alcohol use disorders and sepsis from nonpulmonary sources

Objective -> To determine the association between alcohol dependence and sepsis, septic shock, and hospital mortality among ICU pts

Methods Design Retrospective cohort study. Setting Two ICUs in an urban hospital. Patients 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >1 ICU day and age ≥ 18 yrs

Code based on the International Classification of Diseases, 9th Revision, Clinical Modifications (ICD-9) Alcohol Dependence include ongoing alcoholism and alcohol withdrawal

Results Results Figure 1. Included and excluded subjects in study cohort

Table 1. Differences in demographics and other diagnoses between ICU pts with and without sepsis

Table 2. Differences in demographics and other diagnoses between ICU pts with and without alcohol dependence

Figure 2. Unadjusted differences in selected outcomes for ICU pts with and without alcohol dependence

Table 3. Risk-adjusted association between alcohol dependence and sepsis

Table 4. Risk-adjusted association between alcohol dependence and hospital mortality

Discussion In this study -> one of every 8 pts in the ICU at DHMC had alcohol dependence -> alcohol dependence higher odds of sepsis, septic shock higher hospital mortality fewer hospital-free days -> After risk adjustment, alcohol dependence was independently associated with odds of sepsis, septic shock, and hospital mortality

Alcohol Use Disorders and Sepsis -> increase the risk of severe bloodstream infections, severity of illness, morbidity, and mortality among pts with CAP -> independently associated with the development of the ARDS and increased hospital mortality

Possible Mechanisms of the Association between Alcohol Dependence and Sepsis -> in multiple animal and human studies, abnormal immunity as a result of alcohol exposure innate and adaptive immunity cellular and humoral responses function of neutrophils, monocytes, macrophages and lymphocytes cytokine and chemokine profiles lead to an increased predilection to infection -> alteration of glutathione homeostasis

Conclusions alcohol dependence was independently associated with sepsis, septic shock, and hospital mortality among adult ICU pts -> increase predisposition to infection -> may help to define pathologic mechanisms of sepsis and sepsis-induced organ dysfunction and death