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

Autor:	To DC; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Steel TL; Department of Medicine, University of Washington, Seattle, WA., Carey KA; Department of Medicine, University of Chicago, Chicago, IL., Joyce CJ; Department of Public Health Sciences, Loyola University Chicago, Maywood, IL., Salisbury-Afshar EM; Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI., Edelson DP; Department of Medicine, University of Chicago, Chicago, IL., Mayampurath A; Department of Medicine, University of Wisconsin-Madison, Madison, WI.; Department of Bioinformatics and Medical Informatics, University of Wisconsin-Madison, Madison, WI., Churpek MM; Department of Medicine, University of Wisconsin-Madison, Madison, WI.; Department of Bioinformatics and Medical Informatics, University of Wisconsin-Madison, Madison, WI., Afshar M; Department of Medicine, University of Wisconsin-Madison, Madison, WI.; Department of Bioinformatics and Medical Informatics, University of Wisconsin-Madison, Madison, WI.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2024 Mar 18; Vol. 6 (3), pp. e1066. Date of Electronic Publication: 2024 Mar 18 (Print Publication: 2024).
DOI:	10.1097/CCE.0000000000001066
Abstrakt:	Objectives: Alcohol withdrawal syndrome (AWS) may progress to require high-intensity care. Approaches to identify hospitalized patients with AWS who received higher level of care have not been previously examined. This study aimed to examine the utility of Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) for alcohol scale scores and medication doses for alcohol withdrawal management in identifying patients who received high-intensity care. Design: A multicenter observational cohort study of hospitalized adults with alcohol withdrawal. Setting: University of Chicago Medical Center and University of Wisconsin Hospital. Patients: Inpatient encounters between November 2008 and February 2022 with a CIWA-Ar score greater than 0 and benzodiazepine or barbiturate administered within the first 24 hours. The primary composite outcome was patients who progressed to high-intensity care (intermediate care or ICU). Interventions: None. Main Results: Among the 8742 patients included in the study, 37.5% ( n = 3280) progressed to high-intensity care. The odds ratio for the composite outcome increased above 1.0 when the CIWA-Ar score was 24. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at this threshold were 0.12 (95% CI, 0.11-0.13), 0.95 (95% CI, 0.94-0.95), 0.58 (95% CI, 0.54-0.61), and 0.64 (95% CI, 0.63-0.65), respectively. The OR increased above 1.0 at a 24-hour lorazepam milligram equivalent dose cutoff of 15 mg. The sensitivity, specificity, PPV, and NPV at this threshold were 0.16 (95% CI, 0.14-0.17), 0.96 (95% CI, 0.95-0.96), 0.68 (95% CI, 0.65-0.72), and 0.65 (95% CI, 0.64-0.66), respectively. Conclusions: Neither CIWA-Ar scores nor medication dose cutoff points were effective measures for identifying patients with alcohol withdrawal who received high-intensity care. Research studies for examining outcomes in patients who deteriorate with AWS will require better methods for cohort identification. Competing Interests: Dr. Steel received funding from the National Institute on Alcohol Abuse and Alcoholism K23AA030588. Dr. Mayampurath received funding from the National Heart, Lung, and Blood Institute (NHLBI) K01HL148390. Dr. Matthew Churpek received funding from NHLBI R01HL157262. Dr. Afshar received funding from the National Institute on Drug Abuse R01DA051464. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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