Alcohol withdrawal syndrome in ICU patients: Clinical features, management, and outcome predictors

Abstract

Background Alcohol withdrawal syndrome (AWS) is a common condition in hospitalized patients, yet its epidemiology in the ICU remains poorly characterized. Methods Retrospective cohort of patients admitted to the Nantes University Hospital ICU between January 1, 2017, and December 31, 2019, and coded for AWS using ICD-10 criteria. The objective of the study was to identify factors associated with complicated hospital stay defined as ICU length of stay ≥7 days or hospital mortality. Results Among 5,641 patients admitted to the ICU during the study period, 246 (4.4%) were coded as having AWS. Among them, 42 had exclusion criteria and 204 were included in the study. The three main reasons for ICU admission were sepsis (29.9%), altered consciousness (29.4%), and seizures (24%). At ICU admission, median Cushman’s score was 6 [4–9] and median SOFA score was 3 [2–6]. Delirium tremens occurred in half the patients, seizures in one fifth and pneumonia in one third. Overall, 48% of patients developed complicated hospital stay, of whom 92.8% stayed in the ICU for ≥7 days, 36.7% received MV for ≥7 days, and 16.3% died during hospital stay. By multivariable analysis, two factors were associated with complicated hospital stay: a higher number of organ dysfunctions at ICU admission was associated with a higher risk of complicated hospital stay (OR, 1.18; 95CI, 1.05–1.32, P = 0.005), whereas ICU admission for seizures was associated with a lower risk of complicated hospital stay (OR, 0.14; 95%CI, 0.026–0.80; P = 0.026). Conclusions AWS in ICU patients chiefly affects young adults and is often associated with additional factors such as sepsis, trauma, or surgery. Half the patients experienced an extended ICU stay or death during the hospital stay. The likelihood of developing complicated hospital stay relied on the reason for ICU admission and the number of organ dysfunctions at ICU admission.

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care

“…Despite broadly using receipt of high-intensity care as the outcome, our results showed a dose-dependent response, both within the first 24 hours of presentation and throughout the whole encounter, that suggests a higher severity of alcohol withdrawal correlated with high-intensity care. This is consistent with previous literature where patients with AWS are at an increased risk of complications and prolonged ICU stays (4). In the study cohort, patients who received high-intensity care had a higher frequency of comorbidities, consistent with previous literature suggesting that acute medical illness may precipitate and increase the severity of withdrawal (5–10).…”

Pneumonia risk prediction in patients with acute alcohol withdrawal syndrome through evaluation of sarcopenia index as a prognostic factor

“…Patients with pneumonia were identified based on the diagnosis in the discharge certificate consistent with ICD-10. We referred to the methods of other published literature [ 7 ], did not distinguish between community-acquired pneumonia and hospital-acquired pneumonia, and we included pneumonia that occurred during hospitalization for acute AWS.…”

“…Among adult patients hospitalized for trauma, the rate of pneumonia in the AWS group was 12%, more than five times the rate in non-AWS patients [ 6 ]. In intensive care units, one-third of AWS patients developed pneumonia [ 7 ]. After pneumonia, AWS patients had a higher risk of hospitalization and intensive care unit admission than non-AWS patients [ 8 ].…”

Alcohol Withdrawal Is an Oxidative Stress Challenge for the Brain: Does It Pave the Way toward Severe Alcohol-Related Cognitive Impairment?

“…Several indirect complications of the adrenergic syndrome may also occur during an untreated AW syndrome as dehydration, cardiac failure [ 12 ] or renal failure. Mortality reaches 8% in patients with AW syndrome hospitalized in intensive care units, because of any or the combination of those multiple organs complications [ 13 ]. AW is still considered as a dangerous complication of undetected AUD during any surgery or medical inpatient treatment [ 14 ].…”