Alcohol withdrawal in patients with liver disease

TL;DR

This study found that patients with liver disease experience more severe alcohol withdrawal symptoms, longer hospital stays, and higher mortality compared to those without liver disease.

Contribution

The study provides new insights into the clinical differences in alcohol withdrawal between patients with and without liver disease.

Findings

Patients with liver disease had higher mortality rates and longer hospital stays.

They also showed delayed peak CIWA-Ar scores and required lower lorazepam doses.

No sex differences were found except for a longer time to reach peak CIWA in males.

Abstract

This study investigated and compared the clinical characteristics and treatment outcomes of alcohol withdrawal syndrome (AWS) in patients with and without liver diseases.

We conducted a retrospective chart review of all hospital admissions that received the CIWA-Ar protocol at the Mayo Clinic Health System between June 2019 and June 2022.

In this retrospective cohort study, we analyzed data for 1,586 hospitalizations for 811 liver disease [LIV(+)] patients and compared the results with 14,604 hospitalizations for 9,281 patients without liver disease [LIV(-)].Compared to the LIV(-) group, LIV(+) patients had more alcohol use disorder (94.3% vs. 58%, P = 0.003), longer hospital length of stay [Median (25th, 75th percentiles): 93 (51,173) vs. 69 (43,125) hours, P = 0.001], longer time to reach peak CIWA-Ar scores [Mean ± SD: 26.3 ± 35.9 vs. 2.4 ± 32.5 hours, P = 0.001], lower first 24 hours lorazepam dose equivalents [3.5 (1.5, 7) vs. 3.5 (1.5, 8) mg, P = 0.001], and higher mortality rates (16.8% vs. 5.8%, P = 0.001). Within the LIV (+) cohort, no sex difference was depicted except for longer time to reach peak CIWA in males (Mean ± SD: 28.5 ± 40.3 vs. 21.7 ± 24.5 hours, P = 0.014).

Our study highlights the higher mortality, hospital LOS, and ICU admissions in patients with liver cirrhosis and hepatic failure. We also recommend further controlled studies to examine the severity of AWS in hepatic patients, using other tools besides CIWA-Ar.