L. T. Knowlin1,2, B. A. Cairns1, A. G. Charles1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NORTH CAROLINA, USA 2Howard University Hospital,Surgery,Washington, DISTRICT OF COLUMBIA, USA
Introduction: Approximately half of burn-injured patients have detectable blood alcohol levels at the time of hospital admission. Alcohol use has been hypothesized to exacerbate the immunosuppression process that occurs following burn injury leading to increase morbidity and mortality. We sought to examine the effects of alcohol intoxication on burn injury outcomes.
Methods: Patients ≥14 years old admitted to a large, tertiary care referral burn center between 2002 and 2012 were eligible for inclusion. The effect of alcohol intoxication on infection complications and in-hospital mortality was evaluated using standardized Cox proportional hazard regression. Models were standardized using inverse-probability of treatment weights to account for confounding by patient demographics and burn characteristics.
Results:A total of 1,719 patients were included in the study. Of these,19% (n = 329) had blood alcohol concentration (BAC) > 0 on admission and 13% (n =221) had a blood alcohol concentration above the legal limit (> 0.08). 31% (n=548) developed an infection complications such as pneumonia, wound infectin, urinary tract infection, or sepsis. There was no difference in the crude mortality rate for patients with any positive alcohol use (11% vs 8.6%, p> 0.05) and those with a BAC above the legal limit (12.6% vs 8.6%, p>0.05) compared to sober patients. Intoxicated patients had a higher infection rate compared to sober patients (26% vs 15%, p<0.05). A weighted Cox regression estimated increase hazard of progression to 30 day in-hospital mortality of 12% (HR = 1.12, 95% CI = 0.63-2.00) for positive alcohol use and 64% (HR = 1.64, 95% CI 0.84- 3.22) for BAC above legal limit compared to sober patients but was not significant.The adjusted 60-day cumulative risk for infection complications in alcohol intoxicated patients with inhalation injury was the highest at 35% compared to sober patients with inhalational injury, alcohol intoxicated without inhalational injury and sober without inhalational injury (35% vs. 29.1%, 27.2%, and 22.1%, respectively).(Figure 1)
Conclusion:Alcohol intoxication did not significantly increase risk of inpatient mortality compared to sober individuals following burn injury. However, alcohol intoxication had a significantly higher cumulative risk of infection complications. The immunosuppression response after burn injury is magnified in alcohol intoxicated individuals prompting the need for future therapeutic interventions to reduce poor outcomes among burn patients who drink alcohol.
