Intensive Care Medicine

, Volume 34, Issue 12, pp 2264–2267 | Cite as

Substance dependence and psychiatric disorders are related to outcomes in a mixed ICU population

  • Mary R. Suchyta
  • Callie J. Beck
  • Colin W. Key
  • Al Jephson
  • Ramona O. Hopkins
Brief Report

Abstract

Objective

Substance dependence disorders are common in hospitalized patients and are associated with poor recovery. We compared mortality and discharge disposition in critically ill patients with and without substance dependence and patients with and without psychiatric disorders. We also compared the prevalence of substance dependence and psychiatric disorders to population data.

Methods

All medical records of shock trauma intensive care unit (ICU) patients (mixed medical and surgical) at LDS Hospital were reviewed for pre-critical illness alcohol dependence, drug dependence, and psychiatric disorders.

Results

There were 742 critically ill patients of whom 54% were male, acute respiratory distress syndrome developed in 5.5% and hospital mortality was 21%. The mean acute physiology and chronic health evaluation II scores were 16.5 ± 7.9, sequential organ failure assessment scores were 6.7 ± 4.2, duration of mechanical ventilation was 5 ± 6.2 days, ICU length of stay (LOS) was 7.3 ± 10.1 days, hospital LOS was 12.3 ± 12.9 days. Multivariable regression analyses found psychiatric disorders predicted higher hospital mortality (Odds ratio = 1.50), but was not statistically significant (p = 0.08); substance dependence predicted shorter hospital LOS (R2 = 0.08, = 0.01) after controlling for covariates. There was a higher prevalence of substance dependence compared to Utah (p < 0.001) and US population data (p < 0.001). The prevalence of psychiatric disorders was significantly lower in our patients compared to US population data (19 vs. 26%, p < 0.001).

Conclusions

Our data suggest that substance dependence increases hospital LOS and that patients with drug or alcohol dependence are at higher risk for ICU admission compared to the general population.

Keywords

ICU Critical care Alcohol dependence Drug dependence Substance dependence Psychiatric disorders 

References

  1. 1.
    O’Brien JM Jr, Lu B, Ali NA, Martin GS, Aberegg SK, Marsh CB, Lemeshow S, Douglas IS (2007) Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med 35:345–350PubMedCrossRefGoogle Scholar
  2. 2.
    Chen CH, Chen WJ, Cheng AT (2004) Prevalence and identification of alcohol use disorders among nonpsychiatric inpatients in one general hospital. Gen Hosp Psychiatry 26:219–225PubMedCrossRefGoogle Scholar
  3. 3.
    Yeatman R (2005) A survey of alcohol and drug services to general hospitals in Australia. Australas Psychiatry 13:124–128PubMedCrossRefGoogle Scholar
  4. 4.
    Marik P, Mohedin B (1996) Alcohol-related admissions to an inner city hospital intensive care unit. Alcohol Alcohol 31:393–396PubMedGoogle Scholar
  5. 5.
    Moss M, Parsons PE, Steinberg KP, Hudson LD, Guidot DM, Burnham EL, Eaton S, Cotsonis GA (2003) Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock. Crit Care Med 31:869–877PubMedCrossRefGoogle Scholar
  6. 6.
    Mostafa SM, Murthy BV (2002) Alcohol-associated admissions to an adult intensive care unit: an audit. Eur J Anaesthesiol 19:193–196PubMedCrossRefGoogle Scholar
  7. 7.
    Uusaro A, Parviainen I, Tenhunen JJ, Ruokonen E (2005) The proportion of intensive care unit admissions related to alcohol use: a prospective cohort study. Acta Anaesthesiol Scand 49:1236–1240PubMedCrossRefGoogle Scholar
  8. 8.
    Baldwin WA, Rosenfeld BA, Breslow MJ, Buchman TG, Deutschman CS, Moore RD (1993) Substance abuse-related admissions to adult intensive care. Chest 103:21–25PubMedCrossRefGoogle Scholar
  9. 9.
    Suchyta MR, Hopkins RO, Beck CJ, Jephson A (2006) Prevalence of alcohol abuse, drug abuse, and psychiatric disorders in ICU patients. Proc Am Thorac Soc 3:A737Google Scholar
  10. 10.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  11. 11.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  12. 12.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DCGoogle Scholar
  13. 13.
    Wright D, Sathe N (2005) State estimates of substance use from the 2002–2003 national surveys on drug use and health (DHHS Publication No. SMA 05–3989, NCDUH Series H–26). Substance Abuse and Mental Health Services Administration, RockvilleGoogle Scholar
  14. 14.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602PubMedCrossRefGoogle Scholar
  15. 15.
    Corrigan JD (1995) Substance abuse as a mediating factor in outcome from traumatic brain injury. Arch Phys Med Rehabil 76:302–309PubMedCrossRefGoogle Scholar
  16. 16.
    Bombardier CH, Rimmele CT, Zintel H (2002) The magnitude and correlates of alcohol and drug use before traumatic brain injury. Arch Phys Med Rehabil 83:1765–1773PubMedCrossRefGoogle Scholar
  17. 17.
    Roche AM, Freeman T, Skinner N (2006) From data to evidence, to action: Findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend 83:1–14PubMedCrossRefGoogle Scholar
  18. 18.
    Smothers BA, Yahr HT, Ruhl CE (2004) Detection of alcohol use disorders in general hospital admissions in the United States. Arch Intern Med 164:749–756PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Mary R. Suchyta
    • 1
    • 2
  • Callie J. Beck
    • 3
  • Colin W. Key
    • 3
  • Al Jephson
    • 1
    • 2
  • Ramona O. Hopkins
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of Medicine, Pulmonary and Critical Care DivisionLDS HospitalSalt Lake CityUSA
  2. 2.Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUSA
  3. 3.Psychology Department1001 SWKT, Brigham Young UniversityProvoUSA
  4. 4.Neuroscience CenterBrigham Young UniversityProvoUSA

Personalised recommendations