Risk factors for severe alcohol withdrawal syndrome in Lamphun hospital
DOI:
https://doi.org/10.64838/jmht.2025.276079Keywords:
alcohol withdrawal, delirium tremens, risk factorsAbstract
Objective: To identify factors associated with severe alcohol withdrawal syndrome among patients with alcohol withdrawal syndrome.
Methods: This retrospective study included patients who were hospitalized at Lamphun hospital from October 1, 2022, to September 30, 2023, and presented with alcohol withdrawal syndrome. Demographics, history of alcohol use and related treatment, laboratory results and vital signs at admission, and Alcohol Withdrawal Scale (AWS) scores were retrieved from medical records. Data were analyzed using descriptive statistics and multivariate logistic regression.
Results: Among 190 patients, 87.4% were male with a mean age of 48.9 years. Of these, 38.9% had physical comorbidities, and 93.7% were regular alcohol consumers. Factors significantly increasing risk of developing severe withdrawal syndrome (AWS ≥ 10) included regular alcohol consumption, smoking, history of alcohol withdrawal, prior treatment for alcohol withdrawal, alcohol-induced transient amnesia, abnormal laboratory results (liver function tests, blood sugar/DTX, creatinine, calcium, magnesium, and potassium), systolic blood pressure > 110 mmHg, and pulse rate > 100 beats per minute at admission.
Conclusion: A monitoring and management protocol should be developed for patients at risk of severe alcohol withdrawal syndrome, particularly those with regular alcohol consumption, a history of alcohol withdrawal, and abnormal laboratory or vital sign findings at admission, in order to prevent related complications and mortality.
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Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, et al. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018;113(10):1905-26. DOI: https://doi.org/10.1111/add.14234
National Center for Drug Abuse Statistics. Alcohol abuse statistics [Internet]. South Carolina: National Center for Drug Abuse Statistics; 2023 [cited 2024 Mar 15]. Available from: https://drugabusestatistics.org/alcohol-abuse-statistics/.
Trevisan LA, Boutros N, Petrakis IL, Krystal JH. Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World. 1998;22(1):61-6.
Phatthakorn A, Thippayawong T, Renuwattananon A, Rattanasang P, Rakkanapichonchut W. Clinical practice guideline of alcohol withdrawal patient for multidisciplinary team [Internet]. Pathum Thani: Princess Mother National Institute on Drug Abuse Treatment, Department of Medical Services; 2015 [cited 2024 Mar 15]. Available from: http://www.pmnidat.go.th/thai/downloads/handbook/60/1-58.pdf (in Thai)
Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2014;38(10):2664-77. DOI: https://doi.org/10.1111/acer.12529
Wood E, Albarqouni L, Tkachuk S, Green CJ, Ahamad K, Nolan S, et al. Will this hospitalized patient develop severe alcohol withdrawal syndrome?: the rational clinical examination systematic review. JAMA. 2018;320(8):825-33. DOI: https://doi.org/10.1001/jama.2018.10574
Mayo-Smith MF. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline. JAMA. 1997;278(2):144-51. DOI: https://doi.org/10.1001/jama.1997.03550020076042
Fiellin DA, O’Connor PG, Holmboe ES, Horwitz RI. Risk for delirium tremens in patients with alcohol withdrawal syndrome. Subst Abus. 2002;23(2):83-94. DOI: https://doi.org/10.1080/08897070209511478
Lee JH, Jang MK, Lee JY, Kim SM, Kim KH, Park JY, et al. Clinical predictors for delirium tremens in alcohol dependence. J Gastroenterol Hepatol. 2005;20(12):1833-7. DOI: https://doi.org/10.1111/j.1440-1746.2005.03932.x
Wright T, Myrick H, Henderson S, Peters H, Malcolm R. Risk factors for delirium tremens: a retrospective chart review. Am J Addict. 2006;15(3):213-9. DOI: https://doi.org/10.1080/10550490600625798
Berggren U, Fahlke C, Berglund KJ, Blennow K, Zetterberg H, Balldin J. Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. Alcohol Alcohol. 2009;44(4):382-6. DOI: https://doi.org/10.1093/alcalc/agp012
Eyer F, Schuster T, Felgenhauer N, Pfab R, Strubel T, Saugel B, et al. Risk assessment of moderate to severe alcohol withdrawal—predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol. 2011;46(4):427-33. DOI: https://doi.org/10.1093/alcalc/agr053
Kim DW, Kim HK, Bae EK, Park SH, Kim KK. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med. 2015;33(5):701-4. DOI: https://doi.org/10.1016/j.ajem.2015.02.030
Teetharatkul T, Vittayanont A. Delirium tremens in psychiatric ward at Songklanagarind hospital. Journal of Health Science and Medical Research. 2018;36(3):205-14. DOI: https://doi.org/10.31584/jhsmr.2018.36.3.17
Burapakajornpong N, Maneeton B, Srisurapanont M. Pattern and risk factors of alcohol withdrawal delirium. J Med Assoc Thai. 2011;94(8):991-7.
Lokapan B, Saengcharnchai P, Rattanasumawong W. Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in psychiatric ward. Journal of the Psychiatric Association of Thailand. 2022;67(1):71-86. (in Thai)
Inchum W, Suwan P, Sirichantra N. The factors related to alcohol withdrawal in broken bone with hazardous use patients at Udon Thani hospital. Journal of Nursing and Health Care. 2021;39(1):78-87. (in Thai)
National Statistical Office. Population health behavior survey 2021. Bangkok: National Statistical Office; 2021 [cited 2024 Mar 15]. Available from: https://www.nso.go.th/nsoweb/nso/survey_detail/w6?set_lang=th (in Thai)
Psychiatric Department, Lamphun Hospital. Service profile. Lamphun: Lamphun Hospital; 2022. (in Thai)
Thorndike RL, editor. Educational Measurement. 2nd ed. Washington DC: American Council on Education; 1971.
Clapp P, Bhave SV, Hoffman PL. How adaptation of the brain to alcohol leads to dependence: a pharmacological perspective. Alcohol Res Health. 2008;31(4):310-39.
Nagy J. Alcohol related changes in regulation of NMDA receptor functions. Curr Neuropharmacol. 2008;6(1):39-54. DOI: https://doi.org/10.2174/157015908783769662
Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and precipitating factors associated with delirium. JAMA Netw Open. 2023;6(1):e2249950. DOI: https://doi.org/10.1001/jamanetworkopen.2022.49950
Magny E, Le Petitcorps H, Pociumban M, Bouksani-Kacher Z, Pautas É, Belmin J, et al. Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: a prospective case series. PLoS One. 2018;13(2):e0193034. DOI: https://doi.org/10.1371/journal.pone.0193034
Nagari N, Babu MS. Assessment of risk factors and precipitating factors of delirium in patients admitted to intensive care unit of a tertiary care hospital. Br J Med Pract. 2019;12(2):a011.
Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol. 1995;9(4):210-4. DOI: https://doi.org/10.1016/S0946-672X(11)80026-X
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