Stepwise regression analysis of an intensive 1‐year study of delirium tremens

Abstract

An intensive 1-year study was carried out on 41 male patients, mean age 49, mean hospitalization time 49 days, admitted to a special ward of the Beckomberga Hospital with the diagnosis of delirium tremens and 50 concomitant somatic and psychiatric diagnoses (1--9 per capita), and given a standardized treatment. The mean duration of delirium tremens after admission was 2 days; 76% recovered within 48 h. The duration after admission was positively correlated to age, number of previous delirium tremens, negatively correlated to B-haemoglobin and B-haematocrit for laboratory data obtained within the first 24 h and was positively correlated to blood sugar and S-creatinine on data taken within 40 h (Pearson correlation matrix). Stepwise multiple regression (SWR) based on 46 quantitative and dummy variables (the latter used to represent the presence of various concomitant diseases) was employed to identify the factors predicting the duration of delirium tremens. On final SWR analysis, which limited the number of observations to cases with complete observation vectors, the following regression equation was obtained: Duration after admission = 3.57--0.93 (S-magnesium)--0.29 (B-eosinophils) + 0.62 (liver disease), P greater than 0.05, n = 14. Although the regression coefficients were not statistically significant, S-magnesium, negatively associated with the duration after admission, offered 20% out of the total 38% of explanation given, whereas B-eosinophils, negatively associated, offered 12%, and liver disease, positively associated, 6%. The choice by the SWR program of S-magnesium as the most important factor in predicting the duration of delirium tremens is consistent with clinical evidence that alcohol ingestion causes magnesium diuresis and that magnesium deficiency is present in chronic alcoholism. In view of this knowledge, it is reasonable to assume that the lack of statistical significance is due to the small sample size rather than to the alternative that no explanation is offered by S-magnesium. Furthermore, B-haemoglobin, S-potassium, S-ASAT, and S-ALAT, known to be characteristically altered in delirium tremens, were found on forcing (a variant of SWR) to be of secondary importance to S-magnesium as explaining factors, whereas blood sugar and S-creatinine derived part of their explaining power from S-magnesium. In conclusion, extensive use of SWR analysis based on 46 potential explaining variables points to serum magnesium concentration as the most important factor in predicting the duration of delirium tremens.

Symptom profile and outcome of delirium associated with alcohol withdrawal syndrome: A study from India

“…Second, DT symptoms could have overlapped with the features of alcohol intoxication—many heavily drinking subjects would have minimal period of normalcy between intoxication and delirium, so that the features of intoxication would have rated as features of delirium. In our study the recovery from delirium mostly occurring within the first few days of starting of treatment is consistent with the literature suggesting AWD to usually last for 48–72 hours …”

“…The literature suggests that the clinical features of AWS start within hours of the last alcohol intake, while the clinical features of delirium appear 48–72 or more hours later . In our study the mean duration of onset of delirium after the last alcohol intake was 30.11 hours, with a range of 6–120 hours, and with two‐third of the subjects showing the features of delirium within 24 hours of the last intake seem discrepant.…”

Symptom‐Driven Lorazepam Protocol for Treatment of Severe Alcohol Withdrawal Delirium in the Intensive Care Unit

“…[27][28][29][30] The perception that protracted delirium and confusion past the typical time course of AWD is solely attributable to a prolonged withdrawal state is reinforced by literature reports. [31][32][33] However, this literature consists mainly of case reports that do not rule out other potential reasons for prolonged delirium such as the highdose benzodiazepine therapy. Consequently, continued delirium and disorientation may be perceived as prolonged AWD but are actually attributable to high-dose benzodiazepine therapy.…”

Sex difference in alcohol withdrawal syndrome: a scoping review of clinical studies

“…Because of this heterogeneity, we were unable to conduct a meta-analysis. Despite hundreds of clinical studies on different aspects of alcohol withdrawal, several studies included only male patients ( 18 , 19 , 79 , 80 ). Others included female patients, but the results were merged for both sexes ( 18 , 81–84 ) making drawing a conclusion on sex difference impossible.…”