Risk Assessment of Moderate to Severe Alcohol Withdrawal--Predictors for Seizures and Delirium Tremens in the Course of Withdrawal

F. Eyer,T. Strubel,T. Schuster,N. Felgenhauer,R. Pfab,T. Zilker,B. Saugel

doi:10.1093/alcalc/agr053

F. Eyer, T. Strubel + Show 5 more

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https://doi.org/10.1093/alcalc/agr053

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Abstract

To develop a prediction model for withdrawal seizures (WS) and delirium tremens (DT) during moderate to severe alcohol withdrawal syndrome (AWS) in a large cohort of inpatients treated for AWS (n = 827). Re-analysis of a cohort study population treated between 2000 and 2009. All patients received a score-guided and symptom-triggered therapy for AWS. Multivariable binary logistic regression models with stepwise variable selection procedures were conducted providing odds ratio (OR) estimates. In the multivariable regression, significant predictors of WS during AWS therapy were a delayed climax of withdrawal severity since admission [OR/10 h: 1.23; 95% confidence interval (CI): 1.1-1.4; P < 0.001)], prevalence of structural brain lesions in the patient's history (OR 6.5; 95% CI: 3.0-14.1; P < 0.001) and WS as the cause of admittance (OR 2.6; 95% CI: 1.4-4.8; P = 0.002). Significant predictors at admission for the occurrence of DT were lower serum potassium (OR/1 mmol/l 0.33; 95% CI: 0.17-0.65; P = 0.001), a lower platelet count (OR/100.000 0.42; 95% CI: 0.26-0.69; P = 0.001) and prevalence of structural brain lesions (OR 5.8; 95% CI: 2.6-12.9; P < 0.001). In this large retrospective cohort, some easily determinable parameters at admission may be useful to predict a complicated course of alcohol withdrawal regarding the occurrence of WS or DT. Using the provided nomograms, clinicians can estimate the percentage likelihood of patients to develop either WS or DT during their course of withdrawal. Prevalence of structural brain lesions in the patient's history does strongly warrant a careful observation of patients.

Highlights

В последние годы заболеваемость алкого лизмом, не снижается, а наоборот растет [1, 6]
The work was based on evaluation and treatment of 146 patients with chronic alcoholic intoxication and acute alco holic edematous pancreatitis complicated by delirium tremens admitted to anesthesiology and intensive care department
In Group II, sedation (midazolam (Fulsed) 5 mg/mL at the dose of 0.14 mg/kg i.v., droperidol 2.5 mg/mL at the dose of 0.22 mg/kg i.m.) didn't give necessary effect: 43% patients (n=22) fell asleep ini tially but became agitated during plasmapheresis (+3 according to RASS), 25% patients (n=13) remained to be slightly obtunded ( 1 according to RASS) but continued to «hinder» plasmapheresis

Summary

Introduction

В последние годы заболеваемость алкого лизмом, не снижается, а наоборот растет [1, 6]. Вызванные употреблением алкоголя, составили в 2015 году около 82% всех официаль но зарегистрированных случаев наркологических заболеваний в Российской Федерации. Из них почти 90% составляют лица трудоспособного воз раста — от 20 до 59 лет [5]. Острый панкреатит является полиэтиологи ческим заболеванием и прочно удерживает 3 е место среди всех острых хирургических заболева ний органов брюшной полости [11, 12]. В России наиболее часто (45%) его развитие связано с забо леванием внепеченочных желчных путей и алко гольной интоксикацией (35%) [11, 14]. Тяжесть течения панкреатита делает его ярко выражен ным примером критического состояния [7, 9]

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