The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults

Objective.-To determine the effect of a history of chronic alcohol abuse on the incidence of acute respiratory distress syndrome (ARDS) and in-hospital mortality. Design.-Prospective cohort study. Patients.-A total of 351 medical and surgical intensive care unit patients with one of seven at-risk diagnoses for the development of ARDS. Main Outcome Measures.-The development of ARDS and in-hospital mortality. Results.-Of the 351 patients enrolled in the study, the incidence of ARDS in patients with a history of alcohol abuse was significantly higher than in patients without a history of alcohol abuse (43% vs 22%) (P<.001; relative risk [RR], 1.98; 95% confidence interval [Cl], 1.32 to 2.85), in patients with sepsis, ARDS developed in 52% of the patients with a prior history of alcohol abuse compared with only 20% in patients without a history of alcohol abuse (P<.001; RR, 2.59; 95% Cl, 1.29 to 5.12). Fifty-one percent (52/102) of the patients who developed ARDS died compared with only 14% (36/249) of patients who did not develop ARDS (P<.001). In the subset of patients who developed ARDS, the in-hospital mortality rate was 65% in patients with a prior history of alcohol abuse. This mortality rate was significantly higher (P=.003) than the mortality rate in patients without a history of alcohol abuse (36%). Conclusions.-A prior history of chronic alcohol abuse significantly increases the risk of developing ARDS in critically ill patients with an identified at-risk diagnosis. Our results may be useful in the earlier and more accurate identification of patients at high risk for developing ARDS.