Prevalence of Alcohol Use Characterized by Phosphatidylethanol in Patients With Respiratory Failure Before and During the COVID-19 Pandemic

Abstract

BackgroundAlcohol misuse is frequently overlooked in hospitalized patients, but common among patients with pneumonia and acute hypoxic respiratory failure. Investigations in hospitalized patients heavily rely on self-report surveys or chart abstraction, which lack sensitivity. Therefore, our understanding of the prevalence of alcohol misuse before and during the COVID-19 pandemic is limited. Research QuestionIn critically ill patients with respiratory failure, did the proportion of patients with alcohol misuse, defined by the direct biomarker phosphatidylethanol (PEth), vary over a time period including the COVID-19 pandemic? Study Design and MethodsPatients with acute hypoxic respiratory failure on mechanical ventilation were enrolled prospectively during 2015-2019 (pre-pandemic) and 2020-2022 (pandemic). Alcohol use data, including alcohol use disorders identification test (AUDIT)-C scores, were collected from electronic health records, and PEth was assessed at ICU admission. The relationship between clinical variables and PEth were examined using multivariable ordinal regression. Dichotomized PEth values (≥25 ng/mL) defining alcohol misuse were compared to AUDIT-C scores signifying misuse before and during the pandemic, and correlations between log-transformed PEth and AUDIT-C scores were evaluated and compared by era. Multiple imputation by chained equations was employed to handle missing PEth data. ResultsCompared to pre-pandemic patients (n=144), patients in the pandemic cohort (n=92) included a substantially higher proportion with PEth-defined alcohol misuse (38% versus 90%, p<0.001). In adjusted models, absence of diabetes, COVID-19 positivity, and enrollment during the pandemic were each associated with higher PEth values. The correlation between healthcare worker-recorded AUDIT-C and PEth was significantly lower during the pandemic. InterpretationThe higher prevalence of PEth-defined alcohol misuse during the pandemic suggests that alcohol consumption increased during this time period, identifying alcohol misuse as a potential risk factor for severe COVID-19-associated respiratory failure. Results also suggest that AUDIT-C may be less useful in characterizing alcohol consumption during high clinical capacity.