Authors
Nadezhdin A. V.
MD, PhD, Assistant Professor, Chair for Narcology1
ORCID: 0000-0003-3368-3170
Tetenova E. J.
MD, PhD, Assistant Professor, Chair for Narcology1
ORCID: 0000-0002-9390-621X
Petukhov A. E.
MD, PhD (Pharmacy), Assistant Professor, A.P. Arzamastsev Chair for Pharmaceutical and Toxicological Chemistry, A.P. Nelyubin Institute of Pharmacy2
ORCID: 0000-0002-4855-4235
Davydova E. N.
MD, Deputy Head Physician3
Zolotova E. A.
MD, Head, Pulmonology Department3
Michurina S. V.
MD, Pulmonologist3
1 - Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
2 - Sechenov First Moscow State Medical University, Moscow, Russian Federation
3 - Demikhov Moscow Clinical Hospital, Moscow, Russian Federation
Corresponding Author
Nadezhdin Aleksei; e-mail: aminazin@inbox.ru
Conflict of interest
None declared.
Funding
The study had no sponsorship.
Abstract
Background. Harmful alcohol use is associated with increased risk and severity of outcomes in infectious diseases such as HIV/AIDS, tuberculosis, and pneumonia. Alcohol impairs the ability of lung tissue to respond adequately to inflammation, injury, and infection. General hospitals are considered a convenient setting for treating of individuals with alcohol use disorders. Aim of the study. To study the prevalence of alcohol consumption among acutely ill pulmonary patients, not requiring intensive care, hospitalized in a multidisciplinary urban clinical hospital, using screening self-questionnaires (AUDIT-4) and a highly sensitive and specific marker of chronic alcohol intoxication phosphatidylethanol (PEth). Materials and Methods. We studied the prevalence of alcohol use in pulmonary patients with regard to their socio-demographic characteristics. Statistical analysis was performed using IBM SPSS Statistics 25.0 software. We applied descriptive statistics and multivariate logistic regression model to estimate the impact of socio-demographic and diagnostic predictors on the dependent variable and control for confounders. Results. Peripheral blood PEth values of 0.3 μmol/L or more, indicating excessive alcohol consumption during the 2–4 weeks prior to hospitalization, were observed in 8.5% of pulmonary patients. 5.0% of patients admitted drinking alcohol during the day prior to hospitalization. The highest proportion of alcohol abusers (PEth ≥ 0.3 μmol/L) was observed among patients with pneumonia (Influenza and pneumonia (J09–J18)) – 10.7%. The results of the regression analysis showed that women were negatively associated with PEth level ≥ 0.3 μmol/L compared to men (AOR 0.269; CI 95% 0.139-0.519; p<0.001) and patients with diagnoses from the diagnostic rubric «Chronic lower respiratory diseases» (J40-J47) compared to the reference group of the diagnostic rubric «Influenza and pneumonia» (J09-J18) (AOR 0.537; CI 95% 0.296-0.974; p=0.041). There was a positive association with the level of PEth ≥ 0.3 μmol/L in patients who defined their employment status as «Inactive», compared with the reference group «Active» (AOR 2.268; CI 95% 1.191-4.320; p=0.013) and in individuals in psychological distress (SCL-5≥2) compared with those not in distress (SCL-5<2) (AOR 2.892; CI 95% 1.210-6.910; p=0.017). Significant positive association with a PEth level ≥0.3 μmol/L (OR 7.077; 95% CI 3.485–14.371; p <0.001) was observed in those who admitted drinking alcohol during the day prior to hospitalization compared with the reference group of those who answered negatively. Conclusions: Our findings support the need for brief anti-alcohol interventions in multidisciplinary hospital settings.
Key words
harmful alcohol use, AUDIT-4, phosphatidylethanol, community-acquired pneumonia, alcohol-related disease, pulmonary pathology, brief intervention
DOI
References
1. World Health Organization. Global status report on alcohol and health 2018. Geneve: World Health Organization, 2018. 452 p.
2. Nyberg S.T., Batty G.D., Pentti J., et al. Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank. Lancet Reg Health Eur. 2022; 19: 100417, doi: 10.1016/j.lanepe.2022.100417
3. World Health Organization. Global strategy to reduce the harmful use of alcohol. Geneve: World Health Organization, 2010. 38 p.
4. Rehm J., Baliunas D., Borges G.L., et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105(5): 817-843, doi: 10.1111/j.1360-0443.2010.02899.x
5. Molina P.E., Gardner J.D., Souza-Smith F.M., et al. Alcohol abuse: critical pathophysiological processes and contribution to disease burden. Physiology (Bethesda) 2014; 29(3): 203-215, doi: 10.1152/physiol.00055.2013
6. MacKillop J., Agabio R., Feldstein Ewing S.W., et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022; 8(1): 80, doi: 10.1038/s41572-022-00406-1
7. Kools N., Dekker G.G., Kaijen B.A., et al. Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: a mixed-method study. Subst Abuse Treat Prev Policy 2022; 17(1): 59, doi: 10.1186/s13011-022-00486-y
8. Rautiainen E., Ryynänen O.P., Rautiainen P., et al. How do individuals with alcohol problems use social and healthcare services in Finland? Comparison of service use patterns between two high-need patient groups. Nordisk Alkohol Nark. 2021; 38(5): 450-465, doi: 10.1177/14550725211018593
9. Abrahao K.P., Salinas A.G., Lovinger D.M. Alcohol and the Brain: Neuronal Molecular Targets, Synapses, and Circuits. Neuron. 2017; 96(6): 1223-1238, doi: 10.1016/j.neuron.2017.10.032
10. Fernández-Solá J., Junqué A., Estruch R., et al. High alcohol intake as a risk and prognostic factor for community-acquired pneumonia. Arch Intern Med. 1995; 155(15): 1649-1654, doi: 10.1001/archinte.1995.00430150137014
11. Berkowitz D.M., Danai P.A., Eaton S., et al. Alcohol abuse enhances pulmonary edema in acute respiratory distress syndrome. Alcohol Clin Exp Res. 2009; 33(10): 1690-1696, doi: 10.1111/j.1530-0277.2009.01005.x
12. Rehm J., Baliunas D., Borges G.L., et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105(5): 817-843, doi: 10.1111/j.1360-0443.2010.02899.x
13. Traphagen N., Tian Z., Allen-Gipson D. Chronic Ethanol Exposure: Pathogenesis of Pulmonary Disease and Dysfunction. Biomolecules 2015; 5(4): 2840-2853, doi: 10.3390/biom5042840
14. Arvers P. Alcool et poumon: des liaisons dangereuses [Alcohol consumption and lung damage: Dangerous relationships.] Rev Mal Respir. 2018; 35(10): 1039-1049, doi: 10.1016/j.rmr.2018.02.009 (In French)
15. Moiseev V.S., Garmash I.V., Ogurcov P.P., et al. Alkogol'naya bolezn': Porazhenie vnutrennih organov. [Alcoholic illness: Damage to internal organs.] Moscow: «GEOTAR-Media», 2014. 480 p. (In Russ.)
16. Ostroumova O.D., Popkova A.M., Goloborodova I.V., et al. Alkogol' i legkie. [Alcohol and Lungs.] Consilium Medicum 2018; 20(3): 21-29, doi: 10.26442/2075-1753_20.3.21-29
17. Simou E., Britton J., Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open 2018; 8(8): e022344, doi: 10.1136/bmjopen-2018-022344
18. Sivaraman V., Richey M.M., Nasir A. Alcohol, Cannabis and Crossfading: Concerns for COVID-19 Disease Severity. Biology (Basel) 2021; 10(8): 779, doi: 10.3390/biology10080779
19. Quintero D., Guidot D.M. Focus on the lung. Alcohol Res Health 2010; 33(3): 219-228.
20. Kaphalia L., Calhoun W.J. Alcoholic lung injury: metabolic, biochemical and immunological aspects. Toxicol Lett. 2013; 222(2): 171-179, doi: 10.1016/j.toxlet.2013.07.016
21. Avdeev S.N. Aspiracionnaya pnevmoniya: sovremennye podhody k diagnostike i terapii. [Aspiration pneumonia: modern approaches to diagnosis and therapy.] Pul'monologiya [Pulmonology] 2009; (2): 5-19, doi: 10.18093/0869-0189-2009-2-5-19 (In Russ.)
22. Solov'ev A.G., Vyaz'min A.M., Mordovskij E.A. Izbytochnaya alkogol' atributivnaya smertnost' v g. Arhangel'ske i indikatory ee nepolnogo ucheta (na primere analiza uchetnoj medicinskoj dokumentacii). [Excess Alcohol-Attributed Mortality in Arkhangelsk City and Indicators of its Undercount (By Example of Analysis of Medical Records).] Mediko-biologicheskie i social'no-psihologicheskie problemy bezopasnosti v chrezvychajnyh situaciyah [Biomedical and socio-psychological problems of safety in emergency situations] 2013; (3): 14-19, doi: 10.25016/2541-7487-2013-0-3-14-19 (In Russ.)
23. Mordovskij E.A. Nauchnoe obosnovanie programmy sistemnogo monitoringa i snizhenie masshtaba sovokupnogo ushcherba ot potrebleniya alkogolya v priarkticheskih regionah. Diss. na soiskanie uchenoj stepeni d.m.n. [Scientific justification of the system monitoring program and reduction of the scale of cumulative damage from alcohol consumption in the Arctic regions. Doctor of Medicine thesis]. Central'nyj nauchno-issledovatel'skij institut organizacii i informatizacii zdravoohraneniya [Russian Research Institute of Health]. Ìoscow, 2019. (In Russ.)
24. Solov'yov A.G., Vyaz'min A.M., Mordovskij E.A., Nikulichev V.V. Struktura smertnosti lic, nahodivshihsya pod dispansernym nablyudeniem po povodu vyzvannyh upotrebleniem alkogolya psihicheskih i povedencheskih rasstrojstv. [The Structure of Mortality of Patients Under Dispensary Supervision Diagnosed with Alcohol-Related Mental and Behavioral Disorders.] Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. [S.S. Korsakov Journal of Neurology and Psychiatry] 2015; 115(11): 97-102, doi: 10.17116/jnevro201511511197-102 (In Russ.)
25. Zamyatnina E.S. Struktura neposredstvenno obuslovlennoj alkogolem smertnosti v Rossii v 2011-2021 gg. [The Structure of Directly Related Alcohol Mortality in Russia from 2011 to 2021.] Demograficheskoe obozrenie. [Demographic Review] 2022; 9(2): 102-118, doi: 10.17323/demreview.v9i2.16208 (In Russ.)
26. Zaridze D., Brennan P., Boreham J., et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet 2009; 373(9682): 2201-2214, doi: 10.1016/S0140-6736(09)61034-5
27. Carr T., Kilian C., Llamosas-Falcón L., et al. The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta-analysis. Addiction 2024; 119(7): 1174-1187. doi: 10.1111/add.16456
28. Piano M.R. Alcohol's Effects on the Cardiovascular System. Alcohol Res. 2017; 38(2): 219-241.
29. Babor T., Higgins-Biddle J., Saunders J., et al. The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care. WHO, 2001. 40 p.
30. Gual A., Segura L., Contel M., et al. AUDIT-3 and AUDIT-4: effectiveness of two short forms of the alcohol use disorders identification test. Alcohol Alcohol. 2002; 37(6): 591-596, doi: 10.1093/alcalc/37.6.591
31. Petuhov A.E., Nadezhdin A.V., Bogstrand S.T., et al. Fosfatidiletanol kak biomarker zloupotrebleniya alkogolem. [Phosphatidylethanol as the New Alcohol Abuse Biomarker.] Narkologiya [Narcology] 2017; (2): 42-47. (In Russ.)
32. Petuhov A.E., Mel'nik E.V., Nadezhdin A.V., et al. Razrabotka i validaciya metodiki kolichestvennogo opredeleniya fosfatidiletanola v cel'noj krovi. [Development and Validation of a Method for Quantitative Determination of Phosphatidylethanol in Whole Blood.] Medicina 2022; 10(3): 1-12, doi: 10.29234/2308-9113-2022-10-3-1-12 (In Russ.)
33. Helander A., Hansson T. National harmonization of the alcohol biomarker PEth. Lakartidningen 2013; (110): 1747-1748.
34. Kabashi S., Vindenes V., Bryun E.A., et al. Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study. Drug Alcohol Depend. 2019; (204): 107588, doi: 10.1016/j.drugalcdep.2019.107588
35. Nadezhdin A.V., Tetenova E.J., Kolgashkin A.J., et al. Prediktory lozhnootricatel'nyh rezul'tatov testa AUDIT-4 sredi pacientov mnogoprofil'noj klinicheskoj bol'nicy, gospitalizirovannyh po neotlozhnym pokazaniyam. [Predictors of False Negative AUDIT-4 Test Results Among Acutely Hospitalized Somatic Patients.] Narkologiya [Narcology] 2021; 20(10): 36-48, doi: 10.25557/1682-8313.2021.10.36-48 (In Russ.)
36. Nadezhdin A.V., Tetenova E.J., Kolgashkin A.J., et al. Kross-sekcionnoe issledovanie potrebleniya alkogolya s vrednymi posledstviyami u pacientov, gospitalizirovannyh po neotlozhnym pokazaniyam v nevrologicheskoe otdelenie mnogoprofil'nogo stacionara. [Cross-Sectional Study of Harmful Alcohol Consumption in Acutely Ill Neurological Patients of a General Hospital.] Medicina 2023; 11(1): 77-109, doi: 10.29234/2308-9113-2023-11-1-77-109 (In Russ.)
37. Nadezhdin A.V., Tetenova E.J., Petuhov A.E., et al. Kross-sekcionnoe issledovanie potrebleniya alkogolya s vrednymi posledstviyami u pacientov kardiologicheskogo profilya, gospitalizirovannyh po neotlozhnym pokazaniyam v mnogoprofil'nyj stacionar. [Cross-Sectional Study of Harmful Alcohol Use Among Acutely Ill Cardiac Patients of a Multidisciplinary Clinic.] Medicina 2024; 12(2): 90-113, doi: 10.29234/2308-9113-2024-12-2-90-113 (In Russ.)
38. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007: `147(8): 573-577, doi: 10.7326/0003-4819-147-8-200710160-00010
39. Jørgenrud B., Kabashi S., Nadezhdin A., et al. The Association between the Alcohol Biomarker Phosphatidylethanol (PEth) and Self-Reported Alcohol Consumption among Russian and Norwegian Medical Patients. Alcohol Alcohol. 2021; 56(6): 726-736, doi: 10.1093/alcalc/agab013
40. Govorin N.V., Saharov A.V. Alkogol'noe bremya somaticheskogo stacionara. Tomsk: «Ivan Fedorov», 2010. (In Russ.)
41. Gordeeva N.V., Demko I.V., Korchagin E.E., et al. Osobennosti tyazhelogo techeniya i letal'nyh iskhodov vnebol'nichnyh pnevmonij na primere Krasnoyarskogo kraya. [Features of Severe Course and Fatal Outcomes of Community-Acquired Pneumonia at the Example of Krasnoyarsk Region.] Byulleten' fiziologii i patologii dyhaniya. Byulleten' fiziologii i patologii dyhaniya [Bulletin of physiology and pathology of respiration] 2019; (74): 26-33, doi: 10.36604/1998-5029-2019-74-26-33 (In Russ.)
42. Samokhvalov A.V., Irving H.M., Rehm J. Alcohol consumption as a risk factor for pneumonia: a systematic review and meta-analysis. Epidemiol Infect. 2010; 138(12): 1789-1795, doi: 10.1017/S0950268810000774
43. Shield K.D., Parry C., Rehm J. Chronic diseases and conditions related to alcohol use. Alcohol Res. 2013; 35(2): 155-173.
44. Gutjahr E., Gmel G., Rehm J. Relation between average alcohol consumption and disease: an overview. Eur Addict Res. 2001; 7(3): 117-127, doi: 10.1159/000050729
45. Rehm J., Room R., Graham K., et al. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction 2003; 98(9): 1209-1228, doi: 10.1046/j.1360-0443.2003.00467.x
46. Rehm J., Baliunas D., Borges G.L., et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105(5): 817-843, doi: 10.1111/j.1360-0443.2010.02899.x
47. Shield K.D., Rehm J. Russia-specific relative risks and their effects on the estimated alcohol-attributable burden of disease. BMC Public Health 2015; (15): 482, doi: 10.1186/s12889-015-1818-y
48. Burney P., Perez-Padilla R., Marks G., et al. Chronic Lower Respiratory Tract Diseases. In: Prabhakaran D., Anand S., Gaziano T.A., Mbanya J.C., Wu Y., Nugent R., editors. Cardiovascular, Respiratory, and Related Disorders. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank. 2017. Chapter 15.
49. Kaphalia L., Calhoun W.J. Alcoholic lung injury: metabolic, biochemical and immunological aspects. Toxicol Lett. 2013; 222(2): 171-179, doi: 10.1016/j.toxlet.2013.07.016
50. Lebowitz M.D. Respiratory symptoms and disease related to alcohol consumption. Am Rev Respir Dis. 1981; 123(1): 16-19. doi: 10.1164/arrd.1981.123.1.16
51. Nadezhdin A., Joergenrud B., Tetenova E., et al. Predictors of tobacco smoking among acutely ill patients in a Moscow hospital: A cross-sectional study. Tob Prev Cessat. 2020; 6(6): 18, doi: 10.18332/tpc/117954
52. Mahov M.A. Komorbidnost' alkogol'noj i nikotinovoj zavisimosti. [Comorbidity of Alcohol and Nicotine Dependency.] Narkologiya [Narcology] 2014; 13(6): 91-101. (In Russ.)
53. Mahov M.A. Tabachnaya zavisimost' u bol'nyh alkogolizmom. [Tobacco dependence in alcoholic patients. PhD thesis]. Nacional'nyj medicinskij issledovatel'skij centr psihiatrii i narkologii im. V.M. Bekhtereva [V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology. St. Petersburg (Russia)]. 2018. (In Russ.)
54. O'Keeffe L.M, Taylor G., Huxley R.R., et al. Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ Open 2018; 8(10): e021611, doi: 10.1136/bmjopen-2018-021611