Primary complaints and clinical outcomes of patients presenting to the emergency department following alcohol intake: A retrospective descriptive analysis

Objective: Although acute alcohol intoxication is a common reason for emergency department (ED) presentation, there remains ongoing debate regarding the most appropriate parameters for grading clinical severity in these patients. This study aimed to identify independent risk factors associated with clinical outcomes in a large cohort of adults presenting to the ED after acute alcohol intake and to compare the prognostic value of serum ethanol concentration with that of metabolic biomarkers (lactate, base excess, glucose). Materials and Methods: This single-center, retrospective descriptive study included 2,460 patients aged ≥18 years who presented to a tertiary-care ED between 2014 and 2024 and had a blood ethanol level>10.10 mg/dL. Demographic characteristics, triage categories, presenting complaints, computed tomography (CT) findings, and laboratory parameters were recorded. The composite primary endpoint was defined as an "adverse outcome," comprising intensive care unit (ICU) admission and/or mortality within 30 days to 6 months. Independent predictors of adverse outcomes were identified using multivariable logistic regression analysis. Results: A total of 2,460 patients were analyzed. Adverse outcomes occurred in 90 patients (3.7%); the majority of the cohort were male (85.4%). Serum ethanol levels did not differ significantly between patients with and without adverse outcomes (median 149.0 vs 173.8 mg/dL; p=0.391). In univariable analyses of categorical variables, red triage status was a strong predictor of adverse outcomes (OR 9.88; 95% CI 6.38–15.30), and the proportion of red triage was higher in the adverse outcome group (58.9% vs 12.7%; p<0.001). In ROC analyses of continuous variables, serum ethanol concentration demonstrated poor discrimination (AUC 0.527), whereas base excess (BE) (AUC 0.783) and lactate (AUC 0.730) showed higher discriminatory performance. In multivariable logistic regression, red triage status remained significantly associated with adverse outcomes (β=1.850; OR=6.36; 95% CI 2.40–16.89; p<0.001). Conclusion: In ED patients presenting after acute alcohol intake, serum ethanol concentration is an inadequate parameter for predicting clinical severity and prognosis. Conversely, red triage category, elevated lactate, more negative base excess, and hyperglycemia are strong and independent predictors of adverse outcomes. Management of this population should prioritize a comprehensive assessment of metabolic, physiological, and trauma-related risks rather than focusing primarily on toxicological ethanol levels. Keywords: Alcohol intoxication; emergency department; prognosis; lactate; triage