The relationship between alcohol use and burn injuries is a negative one in multiple ways. Not only are about 50% of adults who sustain burn injuries intoxicated at the time of injury, suggesting that alcohol use may have contributed to the incident, but alcohol use among burn-injured patients is associated with more severe complications, delayed recovery, and increased morbidity and mortality.
“Return to work or normal life can be impaired or delayed for burn-injured patients who use alcohol,” says Elizabeth Kovacs, PhD, vice chair of research and professor of GI, trauma, and endocrine surgery in the University of Colorado Department of Surgery. “Every organ of the body is affected by alcohol because it enters your bloodstream. If you look at the data on alcohol use and injury recovery, it affects everything from the cardiovascular system to the lungs, liver, and pancreas, and even fracture repair.”
That’s primarily because alcohol in the body alters inflammatory responses, she says, making it harder for the immune system to do its job.
“The immune system kills a germ by eating it, like a Pac-Man, and alcohol impairs the ability of that cell to eat the germ,” Kovacs says. “If you get a bacterial infection and your body can’t destroy it, then you're going to have more bacteria, and things will only get worse.”
The problem goes to the brain
In a research study posted online in January in the journal Alcohol, Kovacs describes another possible issue caused by the combination of alcohol and burn injury: impaired cognitive function. Looking at data from patients at the University of Colorado Burn Center, Kovacs and her research team found a correlation between the presence of inflammation markers in the blood of intoxicated burn-injured patients and delirium during the course of hospitalization, as measured by the Confusion Assessment Method tool.
“There are biomarkers that are associated with cognitive dysfunction in humans, which could be Parkinson’s, Alzheimer’s, or other conditions,” Kovacs says. “We’re trying to see if this patient population might have a change in the inflammatory milieu in the blood that would predict a higher incidence of delirium, confusion, and maybe even post-traumatic stress disorder later on.”
Among those biomarkers is the cytokine CCL11, which recently was identified as an indicator of chronic traumatic encephalopathy, a progressive degenerative disease of the brain found in athletes and others with a history of repetitive brain trauma.
“We’re trying to find early biomarkers of potential problems,” Kovacs says. “If we can come up with a panel of biomarkers that indicate that this patient may have more complications than one would expect, then maybe we can come up with more personalized therapies.”
The role of the gut
Kovacs, who has studied the link between alcohol and burn injury for more than two decades, has a theory as to why burn-injured patients who use alcohol have worse outcomes and are at higher risk for delirium — burn injuries to the skin cause the release of chemicals that make their way to other organs, most notably the gut. Because the gut and the brain are closely connected, impaired cognitive function can occur in burn-injured patients whose immune function is impaired by alcohol.
“For people who sustain an injury where alcohol is a factor, we may be able to give them supplements that will improve their gut microbiome, and therefore their immune function, and that may help heal wounds faster and may yield less delirium,” she says.
April is Alcohol Awareness Month, and Kovacs says her research is a timely reminder that alcohol use can have severe and unintended consequences.
“There aren’t any real benefits of alcohol at any level of consumption,” she says. “It’s important to limit or moderate alcohol use. If every patient who comes into the emergency department is asked about their alcohol use, and we can get a realistic assessment of who is really using alcohol at a less healthy level, we might be able to decrease the amount of people who suffer from excessive alcohol use.”