Hospital room scene uid 1344261 In a Spanish hospital, 7% of patients died during 539 episodes of withdrawal.

Most patients who are experiencing alcohol detoxification do not require acute care or specific treatments. For the few with symptoms that are severe enough to require hospitalization, mortality has decreased substantially since the introduction of benzodiazepines more than 40 years ago, but deaths still occur.

To determine risk factors for death, researchers in Spain reviewed medical records for 539 hospitalizations (436 patients) for alcohol withdrawal during 16 years at a single hospital. All patients received clomethiazole, a sedative with efficacy for alcohol withdrawal (not approved for use in the U.S.)

Alcohol withdrawal was the reason for hospitalization in 62% of cases; in the rest, withdrawal developed after admission for other causes. In the 539 cases, 71% of patients had or developed delirium tremens (DTs), 41% developed seizures, and 7% died.

In a multivariable analysis, the following factors were associated with death:

  • hepatic steatosis,
  • cirrhosis,
  • DTs at diagnosis of withdrawal,
  • comorbidities (e.g., hypertension, heart disease, bronchial pathology, diabetes, epilepsy), and
  • need for intensive care unit admission and intubation, particularly in the presence of pneumonia.

Laboratory test results were not significant predictors.

Comment: The report confirms that people with more-severe alcohol withdrawal and medical comorbidities are those most likely to die. Early recognition, prompt pharmacological management, and continued monitoring likely can lower risk.

— Richard Saitz, MD, MPH, FACP, FASAM. Published in Journal Watch General Medicine April 13, 2010. Citation: Monte R et al. Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. Alcohol Alcohol 2010 Mar/Apr; 45:151.