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Prevalence of risk-drinking in critically ill patients, screened with carbohydrate-deficient transferrin and AUDIT-C
Eliisa Uljas1, Ville Jalkanen2, Anne Kuitunen2
1Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
One in three ICU patients exhibit risky alcohol consumption, as indicated by AUDIT-C scores, and one in four show elevated carbohydrate-deficient transferrin (%CDT). Relying on a single screening method may not reliably detect high-risk alcohol use in this population.
Area of Science:
- Critical Care Medicine
- Clinical Biochemistry
- Addiction Medicine
Background:
- Up to one-third of intensive care unit (ICU) admissions are linked to alcohol use.
- Routine screening for alcohol consumption is not standard practice in ICUs.
- Identifying alcohol use is crucial due to its impact on patient outcomes.
Purpose of the Study:
- To determine the prevalence of elevated carbohydrate-deficient transferrin (%CDT) and Alcohol Use Disorders Identification Test, Consumption (AUDIT-C) scores in ICU patients.
- To investigate the association between these alcohol use markers and patient outcomes.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 2532 adult ICU patients over 21 months.
- Measured %CDT and AUDIT-C scores upon ICU admission.
- Used logistic regression to analyze the association of %CDT and AUDIT-C with short- and long-term mortality.
Main Results:
- %CDT was elevated in 23.7% of patients, while 33% had risk-level AUDIT-C scores.
- Patients with risk-level AUDIT-C scores were significantly younger.
- Elevated %CDT correlated with higher illness severity, and AUDIT-C independently predicted long-term mortality.
Conclusions:
- A significant proportion of ICU patients exhibit markers of risky alcohol consumption.
- Prevalence rates differ between %CDT and AUDIT-C, suggesting limitations of single screening methods.
- Combined use of biomarkers and screening tools may be necessary for reliable detection of alcohol use disorders in ICU settings.
Abstract:
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. Methods We conducted a retrospective analysis of clinical and laboratory data from a single ICU where %CDT and AUDIT-C were included in routine assessment. After excluding readmissions, 2532 adult patients from a 21-month period were included. Admission values of %CDT were available for 2049 patients, and AUDIT-C was available for 1617 patients. The association of %CDT and AUDIT-C with short- and long-term outcome was studied by using univariate and multivariate logistic regression analysis. Results %CDT was above the reference value in 23.7% (486/2048) of patients with available %CDT. Of patients with available AUDIT-C, 33% (544/1617) had a risk-level AUDIT-C score. Patients with a risk-level AUDIT-C score were significantly younger than those with a lower score (51 vs 64 years, P < .0001). Increased %CDT was associated with higher severity of illness. AUDIT-C was associated independently with increased risk of long-term mortality in multivariate analysis (P = .007). Conclusion One in three of ICU patients are risk-level alcohol users as measured with AUDIT-C score, and one in four are analysed with %CDT. The prevalence varies according to the method used and any method alone may be insufficient to detect risk-level consumption reliably. Editorial Comment Alcohol overconsumption is associated with need for ICU admission and with less favorable outcomes. Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
