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Research Summary

Predictors of Seizures and Delirium Tremens in the Course of Alcohol Withdrawal

Identifying predictors of alcohol withdrawal seizures (AWS) and delirium tremens (DTs) among patients hospitalized for alcohol withdrawal could be helpful to clinicians. Researchers in Germany retrospectively studied a cohort of 827 adult patients admitted to a hospital intensive-care unit for alcohol detoxification (elective and emergency admissions). All patients received score-guided treatment with clomethiazole started simultaneously with an antiepileptic (valproic acid or carbamazepine) as well as clonidine when noradrenergic hyperactivity was present and haloperidol when there were hallucinations. The researchers used stepwise logistic regression models to identify predictors of AWS and DTs.

  • Of the 827 patients, 5.6% had DTs and 7.4% had AWS.
  • Significant predictors of AWS, independent of medication administered, were past structural brain lesions* (odds ratio [OR], 6.5), AWS as the cause of admission (OR, 2.6), and delayed peak of withdrawal severity since admission (OR for every 10-hour increase, 1.23).
  • Significant predictors of DTs, independent of medication administered, were past structural brain lesions (OR, 5.8), lower platelet count (OR per increase of 100.000, 0.42), and lower serum potassium level (OR per increase of 1 mmol/l, 0.33).
*Past cerebral trauma or hemorrhage, benign or malignant tumor, past neurosurgical interventions, epilepsy.

Comments:

The authors provide 2 nomograms to help clinicians predict the risk of AWS and DTs using available clinical data. By identifying patients at higher risk for AWS or DTs, clinicians could monitor them more closely and treat them earlier and more aggressively if needed. It is important to point out, however, that although analyses were adjusted for the amount of medication received, these results reflect predictors in a cohort receiving a specific treatment and may differ when other medications for alcohol withdrawal, such as benzodiazepines, are prescribed. Results should be replicated in a prospective cohort of patients receiving benzodiazepines. Nicolas Bertholet, MD, MSc

Reference:

Eyer F, Schuster T, Felgenhauer N, 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):427–433.

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