Analysis of the Factors Determining Survival of Alcoholic Withdrawal Syndrome Patients in a General Hospital

• Published in: Alcohol and alcoholism (Oxford) 2010-03, Vol.45 (2), p.151-158
• Main Authors: Monte, R., Rabuñal, R., Casariego, E., López-Agreda, H., Mateos, A., Pértega, S.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcohol Withdrawal Delirium - mortality; Alcohol Withdrawal Seizures - mortality; Alcoholics; Alcoholism; Alcoholism - mortality; Alcoholism - rehabilitation; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Cause of Death; Comorbidity; Delirium; Dying; Female; Hospital Mortality; Hospitals; Hospitals, General; Humans; Intensive care units; Intensive Care Units - statistics & numerical data; Intubation, Intratracheal - statistics & numerical data; Male; Medical sciences; Middle Aged; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Spain; Survival Rate; Toxicology; Withdrawal
• ISSN: 0735-0414; 1464-3502
• DOI: 10.1093/alcalc/agp087

Aim: To investigate the clinical variables associated with the risk of dying and the causes of death during the course of alcoholic withdrawal syndrome (AWS) in a general hospital. Methods: Cohort study of AWS patients admitted to Xeral Hospital in Lugo, Spain between 1987 and 2003. The characteristics of patients who died were contrasted with those who survived. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of the syndrome and its complications were all recorded. Results: There were 539 episodes of hospitalization for AWS in 436 patients (mean age 45.0, SD 12.0, 91.3% males), 71.1% of whom presented with delirium tremens. A total of 29 patients died, yielding a 6.6% mortality rate (95% confidence interval, CI: 4.2–9.1%). Eighteen patients (62%) died after being admitted to the intensive care unit (ICU). The following independent variables were associated with the risk of dying in a multivariate logistic regression model: cirrhosis [odds ratio (OR) 4.8 (95% CI 1.5–14.6), P = 0.006]; presenting with delirium tremens at diagnosis [OR 3.5 (95% CI 1.3–8.9), P = 0.008]; the existence of an underlying chronic pathology other than liver disease [OR 2.5 (95% CI 1–6.1), P = 0.01]; and the need for orotracheal intubation [OR 2.9 (95% CI 1.1–7.9), P = 0.03], especially if pneumonia requiring ICU is added [OR 8 (95% CI 3–21.3), P