The Effect of Chronic Alcohol Abuse on the Incidence of ARDS and the Severity of the Multiple Organ Dysfunction Syndrome in Adults with Septic Shock: An Interim and Multivariate Analysis

doi:10.1378/chest.116.suppl_1.97S-a

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The Effect of Chronic Alcohol Abuse on the Incidence of ARDS and the Severity of the Multiple Organ Dysfunction Syndrome in Adults with Septic Shock^*

An Interim and Multivariate Analysis

Marc Moss, MD; K.P. Steinberg, MD, FCCP; D.M. Guidot, MD; G.F. Duhon; P. Treece; R. Wolken; L.D. Hudson, MD and P.E. Parsons, MD

^* From the Divisions of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, GA; University of Colorado Health Sciences Center, Denver, CO; and University of Washington, Seattle, WA.

Correspondence to: Marc Moss, MD, Suite 5310, Crawford Long Hospital of Emory University, 550 Peachtree St NE, Atlanta, GA 30365

We recently reported that a history of chronic alcohol abusesignificantly increases the risk of developing ARDS. Due tothe use of a less rigorous definition of chronic alcohol abuseand the application of a rigid definition of ARDS, this preliminarystudy may have underestimated the incidence of chronic alcoholabuse and ARDS. In addition, we were unable to account for severalpotentially important confounding variables such as liver diseaseand malnutrition. Furthermore, the effect of chronic alcoholabuse on the severity of dysfunction in other organ systemswas not examined.

Therefore, we initiated a multicenter prospective study to determine theeffect of chronic alcohol abuse on the incidence of ARDS andthe severity of the multiple organ dysfunction syndrome (MODS)in patients with septic shock. A Short Michigan Alcoholism ScoringTest was completed by all patients or their next-of-kin, andchronic alcohol abuse was defined as a Short Michigan AlcoholismScoring Test score of $>=$ 3. ARDS was defined by the American-EuropeanConsensus Conference definition, and the National Heart, Lung,and Blood Institute definition of MODS was used. Because thisis one of two predetermined interim analyses, an alpha of 0.001was required to reach significance.

One hundred seventy-five patients with septic shock were enrolled consecutivelyand their ICU and hospital courses were prospectively followedfor the development of ARDS and MODS. A history of chronic alcoholabuse was identified in 52 of 175 patients (30%). Seventy-one ofthe 175 patients (41%) developed ARDS.

In a univariate analysis, the incidence of ARDS in patientswith a history of chronic alcohol abuse was significantly higherthan in those patients without a history of chronic alcoholabuse (69% vs 28%) (p < 0.0001; relative risk = 2.43; 95%confidence interval = 1.55 to 3.86). In a multivariate analysisadjusting for APACHE (acute physiology and chronic health evaluation)II score, gender, history of cirrhosis, cigarette abuse, andpreexisting malnutrition, the effects of chronic alcohol abuseon the incidence of ARDS remained significant (p = 0.0007; oddsratio = 3.93; 95% confidence interval = 1.80 to 8.90). To determinethe effect of chronic alcohol abuse on other organ systems,a daily aggregate MODS score was calculated, excluding the individuallung score. Based on their highest daily nonpulmonary MODS score,all of the 175 patients were classified as having mild, moderate,or severe nonpulmonary MODS. In both a univariate and an ordinallogistic regression analysis, patients with a history of chronicalcohol abuse developed more severe nonpulmonary MODS when comparedto patients without a history of alcohol abuse (p = 0.003 and0.05, respectively).

We conclude that chronic alcohol abuse is a strong independentrisk factor for ARDS in patients with septic shock. Chronicalcohol abuse may also increase the severity of nonpulmonaryorgan dysfunction in these patients.