Alcohol-related diagnoses and increased mortality in acute myocardial infarction patients: An analysis of the nationwide inpatient sample.

BACKGROUND: Moderate alcohol consumption has been associated with lower risk of coronary heart disease death, but heavy alcohol consumption may increase risk. OBJECTIVE: We sought to determine the association of alcohol-related diagnoses with in-hospital mortality in patients with acute myocardial infarction (AMI). DESIGN/SETTING/PATIENTS: Discharge data collected from all admissions recorded in the Nationwide Inpatient Sample (NIS) database from 2011. A cross-sectional analysis was performed using regression methods appropriate for the NIS sample design. MEASURES: The outcome measures were in-hospital mortality, length of stay, and cardiac procedures. RESULTS: AMI accounted for 610,963 (1.9%) of adult in-patient admissions, with an in-hospital mortality rate of 5.3%. Alcohol-related diagnoses were associated with increased mortality in AMI patients after controlling for factors associated with alcoholism including age, sex, liver disease, hypertension, diabetes, renal failure, peripheral vascular disease, arrhythmias, drug abuse, gastrointestinal bleed, and smoking (adjusted odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.2-1.7, P < 0.001). This association was significant in both ST-elevation myocardial infarction patients (adjusted OR: 1.7, 95% CI: 1.4-2.2, P < 0.001) and non-ST-elevation myocardial infarction patients (adjusted OR: 1.3, 95% CI: 1.0-1.7, P = 0.025). Chronic alcohol-related diagnoses were significantly associated with death, but acute alcohol effects (as estimated by withdrawal and intoxication) were not associated. CONCLUSION: Chronic alcohol-related diagnoses were associated with a modest increase in the risk for death in individuals presenting with AMI. This risk was not accounted for by common alcohol-related comorbidities. As a component of global efforts to limit hospital deaths from AMI, future research should identify the factors underlying this association. Journal of Hospital Medicine 2016;11:563-567. © 2016 Society of Hospital Medicine.

Client attitudes toward alcohol use self-report.

Because psychiatric illnesses and problematic alcohol use frequently co-occur and heavy alcohol use can exacerbate depression and anxiety, mental health clinicians should perform alcohol-use screenings. The aim of this study was to determine if psychiatric patients would be accepting of their mental health clinician screening them for heavy alcohol use. Using a written survey, patients rated their levels of agreement with 9 statements regarding opinions about alcohol screening by their mental-health providers. They also completed the Alcohol Use Disorders Identification Test-C (AUDIT-C), a screening instrument for heavy alcohol use. One hundred fifty-four patients were surveyed in 2 psychiatric outpatient clinics. Nearly 40% screened positively for heavy alcohol use on the AUDIT-C. Nearly 8 out of 10 psychiatric patients were in favor of being screened for alcohol use by either self-report or biomarkers, independent of AUDIT-C status and gender. Thus, mental health clinicians should not be deterred from alcohol screening by perceived negative attitudes from patients.

Liver disease and HPLC quantification of disialotransferrin for heavy alcohol use: a case series.

BACKGROUND: It had previously been suggested that individuals with cirrhosis may have a pattern of transferrin glycosylation that interferes with the interpretation of carbohydrate-deficient transferrin (CDT) testing for heavy alcohol use. The goal of this case series was to evaluate the prevalence of liver disease among individuals with poor resolution of transferrin glycoforms by high performance liquid chromatography. METHODS: We reviewed the electronic medical records of 35 consecutive patients with poor chromatographic resolution of disialotransferrin from trisialotransferrin and recorded information on diagnosed liver disease, liver function testing, and other factors. RESULTS: Thirty of the 35 subjects with poor chromatographic resolution of the transferrin glycoforms had sufficient data in the medical record for some estimation of liver function. Of these 30 subjects, 25 had previously diagnosed liver pathology. Of the remaining 5 subjects, 2 had liver imaging results suggestive of benign tumor; the remaining 3 had mildly elevated bilirubin and aminotransferase activity, and low albumin. CONCLUSIONS: Liver abnormalities, but not necessarily cirrhosis, are common in individuals with poor chromatographic separation of transferrin glycoforms, which might lead to false-positive results on CDT testing. However, the chromatographic-based assay can detect this issue, minimizing the reporting of false positives, but not necessarily assisting in valid detection of heavy drinking.

Prevalence of problem drinking and characteristics of a single-question screen.

Hazardous drinking and alcohol use disorders (i.e, abuse and dependence) are common in Emergency Departments (EDs). This study examined 1) the prevalence of these conditions among ED patients and 2) characteristics of a single screening question (having consumed at least five drinks for males or four for females during a single day). Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Logistic regression for clustered data was used to estimate the relative risk for past-year ED use associated with hazardous drinking, abuse, and dependence. Contingency tables were analyzed to estimate the sensitivity and specificity of the single-question screen for detecting these conditions. Hazardous drinking was not associated with ED utilization. Alcohol abuse was associated with a relative risk of 1.3 (95% confidence interval [CI] 1.1-1.5) and alcohol dependence with a relative risk of 1.9 (95% CI 1.6-2.2). For current drinkers, the single question screen was 0.96, 0.85, and 0.90 sensitive for hazardous drinking, alcohol abuse, and alcohol dependence, respectively. Individuals with a positive screen in the past year were considered at least hazardous drinkers, and specificity was 0.80, 0.64, and 0.65 for hazardous drinking, abuse, and dependence, respectively. Specificity was modestly increased in women. Most problem drinkers were hazardous drinkers, but only severe alcohol use disorders were particularly prevalent in the ED. The single heavy-drinking-day item appears sensitive for problem drinking. Positive tests must be followed by additional assessment to differentiate hazardous drinking from alcohol use disorders.

COMT genotype influences the effect of alcohol on blood pressure: results from the COMBINE study.

BACKGROUND: Heavy drinking can cause chronic hypertension, possibly due to effects on the autonomic nervous system. Catechol- O-methyltransferase (COMT) inactivates catecholamines, and a G to A substitution in codon 108 in the soluble COMT mRNA (or codon 158 in the membrane-bound form) substitutes methionine for valine and alters enzyme activity. METHODS: We evaluated the association of COMT genotype at this locus with blood pressure (BP) in 839 alcohol-dependent individuals before and during participation in an alcoholism treatment trial. Hierarchical linear models were used to account for within-subject correlation on repeated BP measurements, and findings were adjusted for age, gender, ethnicity, alcohol use, body mass index, current smoking, hypertension history, and study site. RESULTS: Relative to those with the val-val genotype, those with the met-met genotype had higher adjusted systolic (+4.9 mm Hg, P < 0.01) and diastolic (+3.2 mm Hg, P < 0.01) BP at baseline. Those with the val-met genotype did not significantly differ from the val-val genotype. Changes in BP between baseline and 4 weeks of alcohol treatment also differed by genotype. Relative to the val-val genotype, the met-met genotype had a greater reduction in adjusted systolic pressure (-3.9 mm Hg, P < 0.01) and diastolic pressure (-2.8 mm Hg, P < 0.01). Corresponding relative reductions for the val-met genotype were -2.2 mm Hg systolic (P = 0.070) and -1.5 mm Hg diastolic (P < 0.05). CONCLUSION: Findings suggest that alcohol-induced BP elevation may be related to the effects of catecholamines and their genetically determined inactivation.

Interest in pharmacotherapy and primary care alcoholism treatment among medically hospitalized, alcohol dependent patients.

This study assessed medically hospitalized alcoholics attitudes about pharmacotherapy and interest in primary care-based treatment. The survey included 50 medical inpatients with current alcohol dependence. Participants were asked to indicate their agreement with the following statements: (1) I need to stop drinking, (2) Some medications can help prevent drinking, (3) If a medication did help prevent drinking, I would like to receive this from a doctor, and (4) I would like a primary care doctor to treat or help treat my drinking problems. Eighty-four percent agreed they needed to stop drinking, 50% agreed that medications help prevent drinking, 66% agreed they would like to receive an effective medication to help prevent drinking, and 32% were interested in primary care treatment. Medically hospitalized patients with alcohol dependence were interested in effective medication for relapse prevention, but primary care follow-up alone may not adequately address patients' perceived treatment needs.

Ethnicity and gamma-glutamyltransferase in men and women with alcohol use disorders.

AIMS: This study evaluated the associations of gender and ethnicity with GGT in a large sample of patients with DSM-IV alcohol abuse or dependence, as well as modification of alcohol's effects on GGT by gender and ethnicity. METHODS: Subjects included 1691 African American, Mexican American, and non-Hispanic white individuals with DSM-IV alcohol dependence or abuse who participated in an alcoholism treatment trial. Detailed information on alcohol use was collected and GGT measured at baseline and at 3, 9, and 15 months post-baseline. RESULTS: Changes in GGT occurring with changes in alcohol consumption were similar regardless of ethnicity. Although alcohol-associated changes were similar in these ethnic groups, African Americans had the highest average GGT at any given level of alcohol use. This ethnic pattern held for both sexes, with females having lower levels within each ethnic group. Drinking frequency had a slightly decreased association with GGT in females relative to males, but this effect was clinically unimportant. CONCLUSIONS: Gender and ethnic-specific cutoffs may be useful when screening for chronic heavy drinking, but the absolute increase in GGT occurring with relapse will be similar regardless of gender or ethnicity.

Screening for alcohol problems: what makes a test effective?

Screening tests are useful in a variety of settings and contexts, but not all disorders are amenable to screening. Alcohol use disorders (AUDs) and other drinking problems are a major cause of morbidity and mortality and are prevalent in the population; effective treatments are available, and patient outcome can be improved by early detection and intervention. Therefore, the use of screening tests to identify people with or at risk for AUDs can be beneficial. The characteristics of screening tests that influence their usefulness in clinical settings include their validity, sensitivity, and specificity. Appropriately conducted screening tests can help clinicians better predict the probability that individual patients do or do not have a given disorder. This is accomplished by qualitatively or quantitatively estimating variables such as positive and negative predictive values of screening in a population, and by determining the probability that a given person has a certain disorder based on his or her screening results.