Abstract
BackgroundA history of prolonged and excessive consumption of alcohol increases the risk for infections. The goal of this study was to investigate circulating white blood cells (WBC) differentiated by flow cytometry and neutrophil CD64 expression in excessive alcohol drinkers versus abstinent or moderate drinkers, and in those with or without infection, in medical patients admitted to the intensive care unit (ICU).MethodsAll patients admitted between September 2009 and March 2010 with an ICU-stay of 3 days or more were eligible for inclusion. Upon admission, hematological exams were conducted by flow cytometry.ResultsOverall, 281 adult were included, with 37% identified as at-risk drinkers. The only significant difference found in circulating WBC between at-risk and not-at-risk drinkers was a lower number of B lymphocytes in at-risk drinkers (P = 0.002). Four groups of patients were defined: not-at-risk drinkers with no infection (n = 66); not-at-risk drinkers with infection (n = 112); at-risk drinkers with no infection (n = 53); and at-risk drinkers with infection (n = 50). Whilst the presence of infection significantly reduced levels of noncytotoxic and cytotoxic T lymphocytes and significantly increased levels of CD16– monocytes in not-at-risk drinkers, with variation related to infection severity, infection had no effect on any of the variables assessed in at-risk drinkers. Post-hoc comparisons showed that B-lymphocyte, noncytotoxic, and cytotoxic T lymphocyte and CD16– counts in at-risk drinkers were similar to those in not-at-risk drinkers with infection and significantly lower than those in not-at-risk drinkers without infection. Neutrophil CD64 index varied significantly between groups, with variations related to infection, not previous alcohol consumption.ConclusionsThese results show that chronic alcohol exposure has an impact on the immune response to infection in critically ill medical patients. The absence of significant variations in circulating WBC seen in at-risk drinkers according to the severity of infection is suggestive of altered immune response.
Highlights
A history of prolonged and excessive consumption of alcohol increases the risk for infections
Sixty-three patients were not included in the study for the following reasons: 41 patients were admitted immediately after surgery; 3 patients were readmitted; 4 patients suffered from postchemotherapy aplasia; and 11 patients were admitted after acute alcohol consumption with a blood alcohol level >1 g/dL
Because our findings suggest that at-risk drinkers admitted to the intensive care unit (ICU) with infection are less prompt to develop intense immune response than not-at-risk drinkers, we believe that systematic and accurate identification of patients with prior alcohol misuse will lead to improved care for these patients
Summary
A history of prolonged and excessive consumption of alcohol increases the risk for infections. Alcohol impairs innate and adaptive immunity [10,11,12,13], whereas nonimmunologic factors potentially associated with chronic and excessive alcohol consumption, such as malnutrition, liver cirrhosis, poor dental hygiene, or active smoking, may contribute to the increased infection risk [2,3]. Alterations in the immune system associated with chronic alcohol consumption have been described primarily in surgical patients [19,20,21]. In this group, alcohol abusers have shown a depressed CD4+ Th1 : Th2 ratio before and after surgery. The impact of chronic alcohol consumption has not been as well described in critically ill medical patients [7,8,22,23]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
