DOI: https://doi.org/10.15587/2313-8416.2015.52156

Predictors of severe alcohol withdrawal state in hospitalised patients

Катерина Юріївна Бєлка

Abstract


The objective of this study was to develop a prediction model for severe alcohol withdrawal syndrome (AWS) in hospitalized AWS patients.

Methods: 336 patients were admitted to this observational prospective study. Multivariable binary regression models with stepwise selection procedures were conducted providing odds ratio (OR) estimates.

Results: In the multivariable regression, significant predictors of severe AWS were: history of AWS [OR: 29; 95 % confidence interval (CI): 14–68; p=0,001]; history of AWS seizures [OR 4; 95 % CI: 1,3–16; p=0,008]; history of other psychoactive drugs (e.g. benzodiazepines, opioids) used [OR 3; 95 % CI: 1,3–10; p=0,04]; tachycardia [OR 5; 95 % CI: 3–11; p=0,0001]; trombocitopenia [OR 3; 95 % CI: 1,5–7]; liver cirrhosis class B [OR 8; 95 % CI: 1,1–344; p=0,04] or C by Child-Pugh [OR 4; 95 % CI: 1,1–21; p=0,03].

Conclusions: In this large prospective study we determine the predictors of severe AWS course in hospitalized patients, they are: history of AWS or AWS seizures, history of other psychoactive drugs (e.g. benzodiazepines, opioids) used, trombocitopenia, liver cirrhosis class B or C by Child-Pugh


Keywords


alcohol withdrawal syndrome; risk factors; predictors; intensive care; alcohol abuse

References


Kanny, D., Liu, Y., Brewer, R. D. et. al (2012). Vital signs: Binge drinking prevalence, frequency, and intensity among adults – United States, 2010. MMWR, 61, 14–19.

Sarff, M., Gold, J. A. (2010). Alcohol withdrawal syndromes in the intensive care unit. Critical Care Medicine, 38, 494–501. doi: 10.1097/ccm.0b013e3181ec5412

Hillemacher, T., Frieling, H., Wilhelm, J., Heberlein, A., Karagülle, D., Bleich, S. et. al. (2012). Indicators for elevated risk factors for alcohol-withdrawal seizures: an analysis using a random forest algorithm. Journal of Neural Transmission, 119 (11), 1449–1453. doi: 10.1007/s00702-012-0825-8

Eyer, F., Schuster, T., Felgenhauer, N., Pfab, R., Strubel, T., Saugel, B., Zilker, T. (2011). Risk Assessment of Moderate to Severe Alcohol Withdrawal – Predictors for Seizures and Delirium Tremens in the Course of Withdrawal. Alcohol and Alcoholism, 46 (4), 427–433. doi: 10.1093/alcalc/agr053

Larson, S. A., Burton, M. C., Kashiwagi, D. T., Hugo, Z. P., Cha, S. S., Lapid, M. I. (2012). Multiple admissions for alcohol withdrawal. Journal of Hospital Medicine, 7 (8), 617–621. doi: 10.1002/jhm.1953

Ramos, R., Mallet, T., Divittis, A., Cohen, R. (2013). Predictors of severity of alcohol withdrawal in hospitalized patients. Journal of Clinical Medicine Research, 5 (5), 376–380. doi: 10.4021/jocmr1514w

Goodson, C. M., Clark, B. J., Douglas, I. S. (2014). Predictors of Severe Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis. Alcoholism: Clinical and Experimental Research, 38 (10), 2664–2677. doi: 10.1111/acer.12529

Kim, D. W., Kim, H. K., Bae, E.-K., Park, S.-H., Kim, K. K. (2015). Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. The American Journal of Emergency Medicine, 33 (5), 701–704. doi: 10.1016/j.ajem.2015.02.030

Shu, J. E., Lin, A., Chang, G. (2015). Alcohol Withdrawal Treatment in the Medically Hospitalized Patient: A Pilot Study Assessing Predictors for Medical or Psychiatric Complications. Psychosomatics, 56 (5), 547–555. doi: 10.1016/j.psym.2014.12.002

Karila, L., Zarmdini, R., Lejoyeux, M. (2014). Delirium tremens. Rev. Prat., 64 (10), 1349–1352.


GOST Style Citations


1. Kanny, D. Vital signs: Binge drinking prevalence, frequency, and intensity among adults – United States, 2010 [Text] / D. Kanny, Y. Liu, R. D. Brewer et. al // MMWR. – 2012. – Vol. 61. – P. 14–19.

2. Sarff, M. Alcohol withdrawal syndromes in the intensive care unit [Text] / M. Sarff, J. A. Gold // Critical Care Medicine. – 2010. – Vol. 38. – P. 494–501. doi: 10.1097/ccm.0b013e3181ec5412

3. Hillemacher, T. Indicators for elevated risk factors for alcohol-withdrawal seizures: an analysis using a random forest algorithm [Text] / T. Hillemacher, H. Frieling, J. Wilhelm, A. Heberlein, D. Karagülle, S. Bleich et. al // Journal of Neural Transmission. – 2012. – Vol. 119, Issue 11. – P. 1449–1453. doi: 10.1007/s00702-012-0825-8 

4. Eyer, F. Risk assessment of moderate to severe alcohol withdrawal--predictors for seizures and delirium tremens in the course of withdrawal [Text] / F. Eyer, T. Schuster, N. Felgenhauer, R. Pfab, T. Strubel, B. Saugel, T. Zilker // Alcohol and Alcoholism. – 2011. – Vol. 46, Issue 4. – P. 427–433. doi: 10.1093/alcalc/agr053

5. Larson, S. A. Multiple admissions for alcohol withdrawal [Text] / S. A. Larson, M. C. Burton, D. T. Kashiwagi, Z. P. Hugo, S. S. Cha, M. I. Lapid // Journal of Hospital Medicine. – 2012. – Vol. 7, Issue 8. – P. 617–621. doi: 10.1002/jhm.1953

6. Ramos, R. Predictors of severity of alcohol withdrawal in hospitalized patients [Text] / R. Ramos, T. Mallet, A. Divittis, R. Cohen // Journal of Clinical Medicine Research. – 2013. – Vol. 5, Issue 5. – P. 376–380. doi: 10.4021/jocmr1514w

7. Goodson, C. M. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis [Text] / C. M. Goodson, B. J. Clark, I. S. Douglas // Alcoholism: Clinical and Experimental Research. – 2014. – Vol. 38, Issue 10. – P. 2664–3677. doi: 10.1111/acer.12529

8. Kim, D. W. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures [Text] / D. W. Kim, H. K. Kim, E.-K. Bae, S.-H. Park, K. K. Kim // The American Journal of Emergency Medicine. – 2015. – Vol. 33, Issue 5. – P. 701–704. doi: 10.1016/j.ajem.2015.02.030

9. Shu, J. E. Alcohol Withdrawal Treatment in the Medically Hospitalized Patient: A Pilot Study Assessing Predictors for Medical or Psychiatric Complications [Text] / J. E. Shu, A. Lin, G. Chang // Psychosomatics. – 2015. – Vol. 56, Issue 5. – P. 547–555. doi: 10.1016/j.psym.2014.12.002

10. Karila, L. Delirium tremens [Text] / L. Karila, R. Zarmdini, M. Lejoyeux // Rev Prat. – 2014. – Vol. 64, Issue 10. – P. 1349–1352.







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