Research Reports - Alcohol intoxication and long-term outcome in patients with traumatic brain injury

J Neurotrauma. 2014 Nov 13

Raj R(1), Skrifvars MB, Kivisaari R, Hernesniemi J, Lappalainen J, Siironen J

The effect of blood alcohol concentration (BAC) on outcome after
traumatic brain injury (TBI) is controversial. We sought to assess the
independent effect of positive BAC on long-term outcome in patients with TBI
treated in the intensive care unit (ICU). We performed a retrospective analysis
of 405 patients with TBI, admitted to the ICU of a large urban Level 1 trauma
center between January 2009 and December 2012. Outcome was six-month mortality
and unfavorable neurological outcome (defined as a Glasgow Outcome Scale score of
1 [death], 2, [vegetative state], or 3 [severe disability]). Patients were
categorized by admission BAC into: no BAC (0.0‰; n=99), low BAC (<2.3‰; n=140)
and high BAC (≥2.3‰; n=166). Logistic regression analysis, adjusting for baseline
risk and severity of illness, was used to assess the independent effect of BAC on
outcome (using the no BAC group as the reference). Overall six-month mortality
was 25% and unfavorable outcome was 46%. Multivariate analysis showed low BAC to
independently reduce risk of six-month mortality compared with no BAC (low BAC
adjusted odds ratio [AOR] 0.41, 95% confidence interval [CI] 0.19-0.88, p=0.021)
and high BAC (AOR 0.58, 95% CI 0.29-1.15, p=0.120). Furthermore, a trend towards
reduced risk of six-month unfavorable neurological outcome for patients with
positive BAC, compared to patients with negative BAC, was noted, although this
did not reach statistical significance (low BAC AOR 0.65, 95% CI 0.34-1.22,
p=0.178, and high BAC AOR 0.59, 95% CI 0.32-1.09, p=0.089). In conclusion, low
admission BAC (<2.3‰) was found to independently reduce risk of six-month
mortality for patients with TBI, and a trend towards improved long-term
neurological outcome was found for BAC-positive patients. The role of alcohol as
a neuroprotective agent warrants further studies.

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