The Impact of Alcohol-Related Diagnoses on Pneumonia Outcomes

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Abstract
Background: There is controversy regarding the role of alcoholism as a prognostic factor in hospitalized patients with pneumonia. Objective: To assess the impact of alcohol abuse on hospitalization charges, length of hospital stay, intensive care unit use, and in-hospital mortality. Methods: We studied a cohort of all adults hospitalized in 1992 in Massachusetts with a principal diagnosis of pneumonia, and all Massachusetts residents hospitalized for pneumonia in 6 bordering states. Results: For the 23 198 pneumonia cases the mean total hospitalization charges were $9925, mean length of hospital stay was 9.6 days, 12% of the cases had intensive care unit stays, and 10% of the cases died during the hospitalization. In bivariate analyses, pneumonia cases with alcoholrelated diagnoses had higher charges (mean, $11 232 vs $9877,P=.07), had shorter length of hospital stay (9.2 vs 9.6 days,P=.02), were more likely to experience an intensive care unit stay (19% vs 12%,P<.001), and had lower in-hospital mortality (6.0% vs 10.2%,P<.001). Multivariable analyses adjusting for comorbidity, pneumonia etiology, and demographics revealed that for pneumonia cases with alcohol-related diagnoses, risk-adjusted hospital charges were $1293 higher (adjusted mean, $11 179 vs $9888,P<.001), length of hospital stay was 0.6 days longer (10.1 vs 9.5 days,P=.001), intensive care unit use was higher (18% vs 12%; adjusted odds ratio, 1.63; 95% confidence interval, 1.33-1.98), and mortality was no different (10% with or without an alcohol-related diagnosis). Conclusions: Having an alcohol-related diagnosis is associated with more use of intensive care, longer inpatient stays, and higher hospital charges. To understand resource utilization in cases of pneumonia, alcohol abuse is a comorbid factor that must be considered. Arch Intern Med. 1997;157:1446-1452