Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis: a multinational, retrospective cohort study

Martí-Aguado, David; Gougol, Amir; Gómez-Medina, Concepción; Jamali, Arsia; Abo-Zed, Abdelrhman; Morales-Arráez, Dalia; Sosa, Alejandro Jiménez; Burns, Keith; Bawa, Aditi; Hernández, Anjara; Pujol, C.; Alvarado‐Tapias, Edilmar; Szafranska, Justyna; Chiu, Wai Kan; Villagrasa, Ares; Ventura‐Cots, Meritxell; Gandicheruvu, Haritha; Lluch, Paloma; Chen, Hui‐Wei; Rachakonda, Vikrant; Duarte‐Rojo, Andrés; Bataller, Ramón

doi:10.1016/j.eclinm.2023.102046

Cited by 6 publications

(7 citation statements)

References 52 publications

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“…A shorter duration of alcohol discontinuation was a predictive factor of recurrence. In line with this finding, recent sobriety has also been associated with higher rates of incident alcohol withdrawal syndrome in patients with alcohol-associated hepatitis ( 8 ).…”

mentioning

confidence: 67%

Impact of low alcohol consumption in the natural history of cirrhosis

Marti-Aguado,

Vilar-Gomez

2024

Hepatobiliary Surg Nutr

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confidence: 67%

Impact of low alcohol consumption in the natural history of cirrhosis

Marti-Aguado,

Vilar-Gomez

2024

Hepatobiliary Surg Nutr

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“… 14 In another study, 32% of patients admitted with AH developed AWS during their hospitalization. 19 …”

Section: Introductionmentioning

confidence: 99%

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

Ratner,

Blaney,

Rastegar

2024

Hepatology Communications

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Alcohol-associated liver disease is a common and severe sequela of excessive alcohol use; effective treatment requires attention to both liver disease and underlying alcohol use disorder (AUD). Alcohol withdrawal syndrome (AWS) can be dangerous, is a common barrier to AUD recovery, and may complicate inpatient admissions for liver-related complications. Hepatologists can address these comorbid conditions by learning to accurately stage alcohol-associated liver disease, identify AUD using standardized screening tools (eg, Alcohol Use Disorder Identification Test), and assess risk for and symptoms of AWS. Depending on the severity, alcohol withdrawal often merits admission to a monitored setting, where symptom-triggered administration of benzodiazepines based on standardized scoring protocols is often the most effective approach to management. For patients with severe liver disease, selection of benzodiazepines with less dependence on hepatic metabolism (eg, lorazepam) is advisable. Severe alcohol withdrawal often requires a “front-loaded” approach with higher dosing, as well as intensive monitoring. Distinguishing between alcohol withdrawal delirium and HE is important, though it can be difficult, and can be guided by differentiating clinical characteristics, including time to onset and activity level. There is little data on the use of adjuvant medications, including anticonvulsants, dexmedetomidine, or propofol, in this patient population. Beyond the treatment of AWS, inpatient admission and outpatient hepatology visits offer opportunities to engage in planning for ongoing management of AUD, including initiation of medications for AUD and referral to additional recovery supports. Hepatologists trained to identify AUD, alcohol-associated liver disease, and risk for AWS can proactively address these issues, ensuring that patients’ AWS is managed safely and effectively and supporting planning for long-term recovery.

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“…AWS is a common condition affecting alcohol-dependent patients who abruptly discontinue or markedly decrease alcohol consumption. A recent study showed that AWS is frequent in patients with AH and negatively affects survival (112). Mild or moderate AWS usually develops within 6–24 hours after the last drink, and symptoms may include nausea/vomiting, hypertension, tachycardia, tremors, hyperreflexia, irritability, anxiety, and headache.…”

Section: Diagnosis and Treatment Of Audmentioning

confidence: 99%

“…Long-acting benzodiazepines (e.g., diazepam and chlordiazepoxide) protect against seizures and delirium; short-acting and intermediate-acting benzodiazepines (e.g., lorazepam and oxazepam) are safer for patients with poor liver function (118,119). Oral administration is preferred for administration of benzodiazepines and barbiturates (112). Patients with AWS and concomitant hepatic encephalopathy should be treated for both conditions.…”

Section: Diagnosis and Treatment Of Audmentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis: a multinational, retrospective cohort study

Cited by 6 publications

References 52 publications

Impact of low alcohol consumption in the natural history of cirrhosis

Impact of low alcohol consumption in the natural history of cirrhosis

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

ACG Clinical Guideline: Alcohol-Associated Liver Disease

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