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

• Published in: Alcohol and alcoholism (Oxford) 2011-07, Vol.46 (4), p.427-433
• Main Authors: Eyer, Florian, Schuster, Tibor, Felgenhauer, Norbert, Pfab, Rudi, Strubel, Tim, Saugel, Bernd, Zilker, Thomas
• Format: Article
• Language: English
• Subjects: Admissions; Adult; Age Factors; Alcohol Withdrawal Delirium - complications; Alcohol Withdrawal Delirium - diagnosis; Alcohol Withdrawal Delirium - epidemiology; Alcohol Withdrawal Seizures - complications; Alcohol Withdrawal Seizures - diagnosis; Alcohol Withdrawal Seizures - epidemiology; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Brain; Brain lesions; Central Nervous System Depressants - adverse effects; Cohort Studies; Confidence intervals; Delirium; Ethanol - adverse effects; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Inpatients; Male; Medical Records; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Patients; Prevalence; Retrospective Studies; Risk Assessment; Seizures; Selection Procedures; Substance Withdrawal Syndrome - complications; Substance Withdrawal Syndrome - diagnosis; Substance Withdrawal Syndrome - epidemiology; Toxicology
• ISSN: 0735-0414; 1464-3502
• DOI: 10.1093/alcalc/agr053

Aims: 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). Methods: 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. Results: 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). Conclusion: 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.