Premorbid hazardous alcohol consumption in critically ill patients

Hazardous alcohol consumption is a global health problem. It has been reported to predispose patients treated in intensive care units (ICUs) to complications and weaken their prognosis. However, the identification of hazardous alcohol consumption is challenging. Various validated questionnaires have been developed for screening, among which the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is widely used. Alcohol brief interventions (BIs) have been proven effective in reducing hazardous alcohol consumption in primary healthcare and hospital settings. The World Health Organization (WHO), among others, recommends screening for alcohol consumption and providing BIs for patients with hazardous alcohol consumption. This dissertation aims to evaluate the prevalence of hazardous alcohol consumption in Finnish ICU patients and to investigate its association with complications, length of stay in the ICU, and mortality. It also seeks to assess the effectiveness of a BI on alcohol consumption after a critical illness. This dissertation encompasses four studies that were conducted with different study populations. Study I was a 21-month retrospective single-center study involving 2,532 adult ICU patients. Data were obtained from the Finnish Intensive Care Consortium (FICC) database and hospital electronic patient records. Carbohydrate-deficient transferrin (%CDT) was included in the routine admission laboratory test package during the study period. Hazardous alcohol consumption was screened for using an AUDIT-C score and elevated %CDT. Study II was a three-month retrospective multicenter study involving 10 Finnish ICUs and included 2,045 patients. Data were retrieved from the FICC database. The study included centers with an AUDIT-C score as part of a comprehensive health evaluation, with a recording rate of at least 70% of admissions. Study III was a 12-month retrospective single-center study on cardiac surgery patients treated in ICUs. Data were collected from the FICC database and hospital electronic patient records. Perioperative data were analyzed for any associations of hazardous alcohol consumption with the length of stay in an ICU, bleeding and infectious complications, and incidence of postoperative arrhythmias, readmissions to the ICU, and mortality. Study IV was a randomized controlled trial on the effectiveness of an alcohol BI in reducing alcohol intake, compared to usual care, for ICU survivors with a history of hazardous alcohol use. The study included 234 patients, 117 of whom were randomized to the BI group; the remaining 117 received usual care. The outcome was self-reported alcohol consumption during the preceding week and a change in the AUDIT-C score six - and 12 months after randomization. Study IV was terminated before the desired sample size was reached, as the COVID-19 pandemic significantly slowed down recruitment. In Study I, the prevalence of hazardous alcohol consumption in ICU patients was 34%, measured by the AUDIT-C score. Admission %CDT values were elevated in 24% of patients. In Study II, the prevalence of hazardous alcohol consumption was 21% in ICU patients, measured by the AUDIT-C score. Patients with hazardous alcohol consumption were mostly men who were considerably younger than ICU patients with non-hazardous alcohol consumption (Studies I, II, and III). Hazardous alcohol consumption was not associated with ICU or hospital mortality (Studies I, II, and III). Long-term mortality was the highest in abstinent patients and patients with high AUDIT-C scores (Studies I and II). In cardiac surgery patients, hazardous alcohol consumption increased the risk of ICU readmissions and severe postoperative infections. No associations with frequency of reoperations, intraoperative bleeding, transfusions, or the incidence of postoperative arrhythmias were found (Study III). In Study IV, a considerable number of ICU survivors reduced their alcohol consumption. No evidence was found to support the hypothesis that an acutely delivered alcohol BI reduces alcohol consumption compared to usual care at the six- and 12-month follow-ups. However, the study was underpowered to confirm or reject the hypothesis. By the one-year follow-up, 12% of all patients had abstained from alcohol use. Hazardous alcohol use is common among patients treated in Finnish ICUs. These patients are mostly men who are significantly younger than the ICU patients without a history of hazardous alcohol consumption. Hazardous alcohol consumption is not associated with poorer short-term outcomes, but it may weaken long-term prognoses. Moreover, it increases the risk of severe postoperative complications after cardiac surgery. Critical illness may compel patients to re-evaluate their hazardous alcohol consumption. As an underpowered study, we cannot reject or confirm the study hypothesis that BIs are effective at reducing alcohol consumption compared to usual care after ICU treatment.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2024

Author dc:creator

• Nissilä, Eliisa

• lääketiede

Statement dc:rights

• This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
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• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/585160

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F585160