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.

Comments:

Several issues limit the utility of these findings: the analysis did not account for multiple admissions of the same patient, patients were treated with a medication known to increase the risk for pneumonia and prolonged ICU stays, and case selection led to a severely ill population from the start. What we can glean from this report is obvious but still useful: people with more severe alcohol withdrawal and medical comorbidity are those most likely to die. Early recognition, prompt pharmacological management, and continued monitoring can likely reduce this risk.

Richard Saitz MD, MPH

Reference:

Monte R, Rabuñal R, Casariego E, et al. Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. Alcohol Alcohol. 2010;45(2):151–8.