酒精依赖与重症患者预后的回顾性队列研究

目的探讨酒精依赖与重症患者的预后的关系。 方法从一个可开放获取的国外重症电子临床数据库中选取重症住院患者，根据是否存在与酒精使用相关的诊断而判断其是否存在酒精依赖。利用Logistic回归和Cox回归模型校正潜在混杂因素并分析存在酒精依赖与重症患者预后（院内死亡、入院后28 d内死亡和入院后90 d内死亡）的关系。 结果共纳入29 487例重症患者，所有患者均在入院后24 h内转入重症监护病房治疗。研究对象的平均年龄为（63.93±17.09）岁，其中7.77%（2292/29 487）的患者存在酒精依赖。在校正年龄、性别、所患疾病以及进入重症监护病房时的疾病严重程度评分等混杂因素后，存在酒精依赖是院内死亡的危险因素（比值比1.28，95%CI 1.05~1.57，P=0.0147），也是入院后28 d内死亡的危险因素（风险比1.25，95%CI 1.06~1.48，P=0.0092），但与入院后90 d内死亡无关联（风险比1.07，95%CI 0.93~1.23，P=0.3239）。 结论存在酒精依赖可能是重症患者短期预后不良的独立危险因素。

Association between alcohol dependence and prognosis in critically ill patients: a retrospective cohort study

ObjectiveTo investigate whether alcohol dependence is associated with the prognosis of critically ill patients. MethodsCritically ill patients were selected from a publicly accessible foreign critical care electronic database, and alcohol dependence was determined based on diagnoses related to alcohol abuse. Logistic regression and Cox regression models were used to adjust potential confounding factors and analyze the associations between alcohol dependence and prognosis of the critically ill patients including hospital mortality, 28-day mortality, and 90-day mortality after hospital admission. ResultsA total of 29 487 critically ill patients were included in the study. All patients were transferred to intensive care units within 24 h after hospital admission. The average age of the study population was (63.93±17.09) years, and 7.77% (2292/29 487) of them were alcohol-dependent. After adjusting for potential confounders mainly including age, sex, comorbidities, and disease severity scores when admitted to intensive care unit, alcohol dependence was found to be a risk factor for hospital mortality (odds ratio=1.28, 95% confidence interval: 1.05-1.57, P=0.0147), and 28-day mortality after admission (risk ratio=1.25, 95% confidence interval: 1.06-1.48, P=0.0092), but there was no statistically significant association with 90-day mortality after admission (risk ratio=1.07, 95% confidence interval: 0.93-1.23, P=0.3239). ConclusionComorbid alcohol dependence might be an independent risk factor for poor short-term prognosis in critically ill patients.