Base deficit and triage, not blood ethanol, predict poor outcome after acute alcohol ingestion: a 10-year cohort study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Clinicians often anchor on the blood ethanol concentration when judging the severity of acute alcohol ingestion, yet its prognostic value is uncertain. We compared the blood ethanol concentration with routinely available markers of physiological derangement for predicting a poor outcome in emergency department (ED) patients with acute alcohol ingestion. Methods This single-centre retrospective cohort study included adults (≥ 18 years) presenting to a tertiary ED between September 2014 and September 2024 with a blood ethanol concentration > 10.1 mg/dL; co-ingestions and toxic-alcohol exposures were excluded. The primary outcome was a composite of intensive care unit (ICU) admission and/or all-cause mortality at 30 days or 6 months. Discrimination was assessed with the area under the receiver-operating-characteristic curve (AUC); independent predictors were identified by multivariable logistic regression with bootstrap internal validation. Analyses were repeated after stratification by presentation type (trauma versus non-trauma). Results Of 2,460 patients (85.4% male; median age 35 years), 90 (3.7%) had a poor outcome. Blood ethanol did not discriminate poor outcome overall (AUC 0.527), whereas base deficit (0.783), bicarbonate (0.768), lactate (0.730) and admission glucose (0.690) discriminated moderately to well. Base deficit performed similarly in non-trauma (0.790) and trauma (0.770) strata. Among non-trauma presentations, patients with a poor outcome had a lower median ethanol concentration (129.9 versus 185.2 mg/dL; p = 0.021). A model combining red triage, base deficit and pathological computed tomography achieved an optimism-corrected AUC of 0.874. Conclusions In ED patients with detectable ethanol, the ethanol concentration is a poor predictor of poor outcome, whereas base deficit, lactate, admission glucose and red triage are stronger, readily available markers. Risk stratification should rest on physiological and structural assessment rather than the toxicological level.
Source: Research Square
Authors: Yasin Haydar Yartaşı, Salih Karakoyun
Institutions: Düzce Atatürk Devlet Hastanesi, Düzce Üniversitesi
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225261377