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Marc Moss, MD; Becki Bucher, PhD; Frederick A. Moore, MD; Ernest E. Moore, MD; Polly E. Parsons, MD

JAMA. 1996;275(1):50-54.

Abstract
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 [CI], 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% CI, 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.

(JAMA. 1996;275:50-54)

Author Affiliations
From the Departments of Medicine (Drs Moss and Parsons) and Surgery (Drs Moore and Moore), Denver (Colo) General Hospital; the Departments of Medicine (Dr Parsons) and Biostatistics (Dr Bucher), National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo; and the Departments of Medicine (Drs Moss and Parsons) and Surgery (Drs Moore and Moore), University of Colorado Health Sciences Center, Denver. Dr Moss is now with Crawford Long Hospital and the Carlyle Fraser Heart Center, Emory University, Atlanta, Ga.

Footnotes
Reprint requets to Crawford Long Hospital, Emory University, 550 Peachtree St NE, Suite 5320, Atlanta, GA 30365 (Dr Moss).

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