Wednesday, January 6, 2016

Survival of the Intoxicated

We are mostly all familiar with the beneficial social outcomes associated with occasional alcohol use.  However, we also see the detrimental effects of chronic use in the context of comorbid disease states.

But, it’s apparently not all bad news in a medical sense.

This retrospective evaluation of patients admitted to medical and surgical critical care units in teaching hospitals in Boston simply tracked outcomes segregated by admission blood alcohol level.  Evaluating 11,850 admissions, most admitted patients had undetectable BAC, while 638, 703, and 1,226 patients fell into their three strata of increasing BAC.

Unsurprisingly, as most patients with the highest BAC had the fewest comorbid factors and were overwhelmingly admitted due to trauma, they had the lowest mortality in the unadjusted analysis.  However, across several different types of multivariate adjustment and propensity scoring, the same survival advantage held, although substantially weakened.

There is some school of thought alcohol confers a neuroprotective and anti-inflammatory effect in the setting of acute illness.  These retrospective data, fraught with potential confounders, are inadequate to conclusively confirm or refute such a hypothesis – but it is reasonable to suggest further study of underlying mechanisms may be warranted.

“Association between blood alcohol concentration and mortality in critical illness”

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