Alcohol screening scores and the risk of intensive care unit admission and hospital readmission

ABSTRACT

Background: The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. Methods: This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. Results: Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%–2.3%) for abstinent patients, 1.6% (95% CI: 1.3%–1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%–2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%–2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%–49%) in abstinent patients, 44% (42%–45%) in patients with lower-risk alcohol use, 42% (39%–45%) in patients with moderate alcohol misuse, and 55% (49%–60%) in patients with severe alcohol misuse. Conclusions: Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.

KEYWORDS:

• Alcohol abuse
• alcohol consumption
• alcohol-related disorders
• intensive care units
• patient readmission
• health care utilization

Author contributions

Dr. Clark takes responsibility for the content of the manuscript. Drs. Bradley and Rubinsky had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Bradley, Clark, and Moss were responsible for the study concept and design. Drs. Clark, Rubinsky, Moss, Au, Ho, Chavez, and Bradley participated in the acquisition, analysis, and/or interpretation of the data. Drs. Clark and Rubinsky drafted the manuscript. All authors provided critical revision of the manuscript for important intellectual content. Statistical analysis was performed by Dr. Rubinsky. Dr. Bradley obtained funding.

Funding

This work was supported by Merit Review Award no. IIR 08-314 from the United States Department of Veterans Affairs Health Services Research and Development Program, the Center of Excellence for Substance Abuse Treatment and Education, NIH/NCATS Colorado CTSI Grant Number UL1 TR001082, the National Institute on Alcohol Abuse and Alcoholism (K23 AA 021814), the National Heart Lung and Blood Institute (K24 HL 089223), and the Agency for Healthcare Research and Quality (R36 HS 022800). Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (project numbers SDR 02–237 and 98–004). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States Government, or any of the authors' institutions. The funding agencies were not involved in the design of this study, analysis of data, or preparation of the manuscript. The authors declare that they have no conflicts of interest.