Factors Associated with Mortality in Alcohol Withdrawal
Most patients with alcohol withdrawal syndrome do not require acute care or specific treatments. For the minority with syndromes severe enough to require hospitalization, mortality has decreased substantially since the introduction of benzodiazepines beginning 40 years ago. But, deaths still occur. To determine the risk factors, researchers in Spain reviewed 16 years of medical records at 1 hospital and identified 436 patients with alcohol withdrawal accounting for 539 hospitalizations. All patients had been treated with chlormethiazole, a non-benzodiazepine sedative with efficacy for alcohol withdrawal that is not approved for use in the US.
- Alcohol withdrawal was the reason for hospitalization in 62% of the 539 cases. Seventy-one percent had or developed delirium tremens (DTs) (236 and 147 cases, respectively), and 41% developed seizures. Seven percent of patients died during an episode of withdrawal.
- The following factors were associated with death in a multivariable analysis: hepatic steatosis, cirrhosis, DTs at the time of withdrawal diagnosis, comorbidity (hypertension, heart disease, bronchial pathology, diabetes, epilepsy), and the need for intensive care unit (ICU) admission and intubation, particularly in the presence of pneumonia.
- Laboratory test results were not retained as significant predictors.