The Role of Alcohol in Severe Pneumonia and Acute Lung Injury

Abstract

Community-acquired pneumonia remains an important cause of considerable morbidity and mortality in both the first world and in developing countries (1, 2, 3, 4, 5). More recently severe community-acquired pneumonia has been designated as a separate clinical entity that is important to recognize because of its particularly high mortality, special etiology requiring more focused empiric therapy and the potential benefit of early intensive care unit (ICU) admission (3, 4, 5). Severe community-acquired pneumonia accounts for approximately 3-5% of cases of community-acquired pneumonia and 10% of ICU admissions (4). Most cases are admitted to the ICU for severe respiratory failure (4). While some 30% of cases of severe community-acquired pneumonia occur in otherwise previously healthy individuals, most patients with community-acquired pneumonia have underlying diseases, of which chronic obstructive airways disease, alcoholism and diabetes mellitus are said to be the most frequent (4,6). High alcohol intake has been found not only to be an independent risk factor for community-acquired pneumonia but, alcoholic-patients have been shown to have more infections with Gram-negative bacilli, more severe clinical symptoms, more multilobar involvement, as well as slower resolution of pulmonary infiltrates, and to require more prolonged intravenous therapy, and a longer hospital stay (6). Importantly, high alcohol intake has also been shown to be an important negative prognostic factor in community-acquired pneumonia (6).