RESUMEN
OBJECTIVE: This study aimed to explore the relationship between the sarcopenia index (SI) and the risk of pneumonia in hospitalized patients with acute alcohol withdrawal syndrome (AWS). STUDY DESIGN: We have performed a retrospective study of individuals with AWS from a teaching hospital in western China. Patients' data were retrieved from the medicinal record databases. Patients' primary (upon admission) blood serum creatinine (Cr) and cystatin C (CysC) levels were incorporated into the records. Participants were separated into low and high SI cohorts based on the three-quarter digit of SI (SI = serum Cr/serum CysC ratio × 100). The association between SI and the risk of pneumonia in hospitalized patients with AWS was assessed by logistic regression analysis. RESULT: Three hundred and twelve patients with acute AWS were included in this retrospective analysis. Among hospitalized patients with acute AWS, the incidence of pneumonia was 13.78%. The average median age of acute AWS patients with pneumonia was 55.28 (10.65) years, and the mean age of acute AWS individuals without pneumonia was 51.23 (10.08) years. In the univariate analysis, the high SI group (SI > 87.91) had a lower incidence of pneumonia than the low SI group (SI ≤ 87.91) (high SI vs. low SI, 6.41% vs. 16.24%, p = 0.029). Further logistic regression analysis showed that the high SI group demonstrated a poorer risk of pneumonia (OR = 0.353, 95%CI: 0.134-0.932, p = 0.036). After adjusting for possible confounders, the risk of pneumonia remained low in the high SI group (OR = 0.358, 95%CI: 0.132-0.968, p = 0.043). CONCLUSION: Our results showed that SI was linked with the risk of pneumonia in hospitalized individuals with acute AWS. We further suggest that it could be a pneumonia risk factor, especially in medical centers where sarcopenia diagnosis is unavailable.
Asunto(s)
Alcoholismo , Neumonía , Sarcopenia , Síndrome de Abstinencia a Sustancias , Humanos , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Pronóstico , Estudios Retrospectivos , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Neumonía/complicaciones , Neumonía/diagnósticoRESUMEN
Alcohol addiction is one of the most common health problems. Long-term consumption of high doses of ethanol leads to numerous adaptive changes in the central and peripheral nervous systems, most notably a decrease in the activity of inhibitory GABAergic pathways and an increase in the activity of excitatory glutamatergic pathways. Up to half of patients may develop alcohol withdrawal syndrome (AWS) when they stop drinking alcohol. This article contains the recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research for the pharmaco�therapy of AWS. This paper presents the aetiopathogenesis, neurotransmitter and receptor mechanisms, symptoms and diagnostic criteria of AWS, medications used in the treatment of alcohol withdrawal syndromes, management of uncomplicated and complicated alcohol withdrawal syndromes, and discusses the management of special populations. Firstline drugs in the management of AWS are benzodiazepines (BDZ). Most studies have not shown a su�periority of any BDZ in the treatment of AWS. The decision to choose a formulation should be based on its pharmacokinetic properties, comorbidities, and the patient's current condi�tion. The most commonly used BDZs are diazepam, lorazepam, oxazepam, and clorazepate.
Asunto(s)
Alcoholismo , Síndrome de Abstinencia a Sustancias , Humanos , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Alcoholismo/tratamiento farmacológico , Polonia , Benzodiazepinas/uso terapéutico , Etanol/efectos adversosRESUMEN
BACKGROUND: Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS. METHODS: Patients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded. RESULTS: The majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275-675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05). CONCLUSION: The prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.
Asunto(s)
Alcoholismo/complicaciones , Magnesio/sangre , Síndrome de Abstinencia a Sustancias/sangre , Síndrome de Abstinencia a Sustancias/mortalidad , Tiamina/sangre , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Abstinencia a Sustancias/patologíaRESUMEN
BACKGROUND: The Wetterling alcohol withdrawal syndrome (AWS) scale determines withdrawal severity and guides treatment. We investigated associations between maximum AWS scores and clinical outcomes. METHODS: This retrospective cohort study considered AWS assessments measured from 8/2015-8/2017. We used multivariable linear and logistic regression to analyze associations between the maximum score and increased length of stay (LOS) and in-hospital mortality, respectively. Firstly, we investigated the maximum score of all AWS assessments any time during the stay, secondly, the maximum measured only within the first 3 days of withdrawal. RESULTS: A total of 2,464 hospital stays showed that, patients with "mild" (<6), "moderate" (6-9), and "severe" (>9) maximum scores had median LOS of 5.93, 9.35, 14.71 days, mortality was 1.7%, 4.8%, 8.0%, respectively. Regression showed that a higher maximum score was independently associated with increased LOS and mortality (both pâ¯<â¯0.001). Based on the maximum AWS score within the first 3 days, the median LOS was 6.18, 9.00, 12.89 days, mortality was 2.2%, 3.6%, 7.6%, respectively. A higher maximum score in the first 3 days was independently associated with increased LOS (pâ¯=â¯0.036) and mortality (pâ¯=â¯0.001). Severe maximum AWS scores within 3 days of withdrawal had an odds ratio of 2.53 (95% CI: 1.27, 4.82; pâ¯=â¯0.0060) for in-hospital death. CONCLUSIONS: Maximum AWS scores associate independently with increased LOS and in-hospital mortality. This association is reproducible within the first 3 days of withdrawal. Development of such a 3-day tool could help clinicians assess the risk of worse clinical outcomes early on and adjust care accordingly.