Predictors of resistant alcohol withdrawal (RAW): A retrospective case-control study. (1st November 2018)

• Record Type: Journal Article
• Authors: Benedict, Neal J.; Wong, Adrian; Cassidy, Elizabeth; Lohr, Brian R.; Pizon, Anthony F.; Smithburger, Pamela L.; Falcione, Bonnie A.; Kirisci, Levent; Kane-Gill, Sandra L.
• Is Part Of: Drug and alcohol dependence. Volume 192(2018)
• Page Start: 303
• Page End: 308
• Publication Date: 2018-11-01
• Subjects: Alcohol-induced disorders -- Risk factors -- Substance withdrawal syndrome -- Psychoses -- Substance-induced -- Alcoholism; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2018.08.017
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Thrombocytopenia doubles likelihood of benzodiazepine-resistant alcohol withdrawal. Patient with psychiatric history 2 times more likely to be benzodiazepine resistant. 1-unit increase comorbidity or severity illness decreases benzodiazepine resistance. Benzodiazepine-resistance associated with abnormal admission liver enzymes. Caucasian race and male gender more predictive of benzodiazepine resistance. Abstract: Background: Benzodiazepine-resistant alcohol withdrawal (RAW), defined by a requirement of ≥ 40 mg of diazepam in 1 h, represents a severe form of withdrawal without predictive parameters. This study was designed to identify risk factors associated with RAW versus withdrawal without benzodiazepine resistance (nRAW). Methods: A retrospective cohort of adults with severe alcohol withdrawal were screened. Demographic and clinical variables, collected through chart review, underwent logistic regression to select the subset that predicst RAW. Results: 736 patients (515 nRAW, 221 RAW) were analyzed. RAW patients were younger (P < 0.001), male (P = 0.008) Caucasians (P = 0.037) with histories of psychiatric illness (P < 0.001), higher serum ethanol concentrations (P < 0.007), and abnormal liver enzymes (P = 0.01). RAW patients had significantly lower platelets (P < 0.001), chloride (P = 0.02), and potassium (P = 0.01) levels; severity of illness (SAPSII) (P < 0.001) and comorbidity scores (P < 0.001). Caucasian race and male gender were found to be 3.6 and 2.6 times more likely to be RAW. For every 1-unit increase in comorbidity and severity of illness scores, patients were 22% [OR(95% CI) 0.78 (0.66–0.90)] and 4% [0.96 (0.93–0.98)] less likely to be RAW. Patients with a psychiatric history or thrombocytopenia were 2 times more likely [2.02 (1.24–3.30); 2.13 (1.31–3.50), respectively] to be RAW. Conclusion: These data demonstrate the predictive ability of a history of psychiatric illness, thrombocytopenia, gender, race, baseline severity of illness and comorbidity scores for developing RAW. Considering these characteristics in early withdrawal management may prevent progression to RAW outcomes.