Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis

The prevalence and impact of alcohol withdrawal syndrome (AWS) in patients with alcohol-associated hepatitis (AH) are unknown. In this study, we aimed to investigate the prevalence, predictors, management, and clinical impact of AWS in patients hospitalized with AH. A multinational, retrospective co...

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Detalhes bibliográficos
Autores: Marti-Aguado, David, Gougol, Amir, Gomez-Medina, Concepcion, Jamali, Arsia, Abo-Zed, Abdelrhman, Morales-Arraez, Dalia, Jimenez-Sosa, Alejandro, Burns, Keith, Bawa, Aditi, Hernández, Anjara, Pujol, Claudia, Alvarado-Tapias, Edilmar|||0000-0003-2036-6133, Szafranska, Justyna|||0000-0003-0467-8479, Chiu, Wai Kan, Villagrasa, Ares|||0000-0003-0928-0427, Ventura-Cots, Meritxell|||0000-0001-9513-2855, Gandicheruvu, Haritha, Lluch, Paloma, Chen, Hui-Wei, Rachakonda, Vikrant, Duarte-Rojo, Andres, Bataller, Ramon|||0000-0002-1119-7799
Tipo de documento: artigo
Data de publicação:2023
País:España
Recursos:Universitat Autònoma de Barcelona
Repositório:Dipòsit Digital de Documents de la UAB
Idioma:inglês
OAI Identifier:oai:ddd.uab.cat:282344
Acesso em linha:https://ddd.uab.cat/record/282344
https://dx.doi.org/urn:doi:10.1016/j.eclinm.2023.102046
Access Level:Acceso aberto
Palavra-chave:Alcohol-associated hepatitis
Alcohol use disorder
Alcohol withdrawal syndrome
Benzodiazepines
Descrição
Resumo:The prevalence and impact of alcohol withdrawal syndrome (AWS) in patients with alcohol-associated hepatitis (AH) are unknown. In this study, we aimed to investigate the prevalence, predictors, management, and clinical impact of AWS in patients hospitalized with AH. A multinational, retrospective cohort study enrolling patients hospitalized with AH at 5 medical centres in Spain and in the USA was performed between January 1st, 2016 to January 31st, 2021. Data were retrospectively retrieved from electronic health records. Diagnosis of AWS was based on clinical criteria and use of sedatives to control AWS symptoms. The primary outcome was mortality. Multivariable models controlling for demographic variables and disease severity were performed to determine predictors of AWS (adjusted odds ratio [OR]) and the impact of AWS condition and management on clinical outcomes (adjusted hazard ratio [HR]). In total, 432 patients were included. The median MELD score at admission was 21.9 (18.3-27.3). The overall prevalence of AWS was 32%. Lower platelet levels (OR = 1.61, 95% CI 1.05-2.48) and previous history of AWS (OR = 2.09, 95% CI 1.31-3.33) were associated with a higher rate of incident AWS, whereas the use of prophylaxis decreased the risk (OR = 0.58, 95% CI 0.36-0.93). The use of intravenous benzodiazepines (HR = 2.18, 95% CI 1.02-4.64) and phenobarbital (HR = 2.99, 95% CI 1.07-8.37) for AWS treatment were independently associated with a higher mortality. The development of AWS increased the rate of infections (OR = 2.24, 95% CI 1.44-3.49), the need for mechanical ventilation (OR = 2.49, 95% CI 1.38-4.49), and ICU admission (OR = 1.96, 95% CI 1.19-3.23). Finally, AWS was associated with higher 28-day (HR = 2.31, 95% CI 1.40-3.82), 90-day (HR = 1.78, 95% CI 1.18-2.69), and 180-day mortality (HR = 1.54, 95% CI 1.06-2.24). AWS commonly occurs in patients hospitalized with AH and complicates the hospitalization course. Routine prophylaxis is associated with a lower prevalence of AWS. Prospective studies should determine diagnostic criteria and prophylaxis regimens for AWS management in patients with AH. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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