Risk for delirium tremens in patients with alcohol withdrawal syndrome.
To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case-control study at the detoxification units of two hospitals. Cases met DSM-IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94-10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21-14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92-25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI 4.36-460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens.
Fiellin
David A
DA
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA. david.fiellin@yale.edu
O'Connor
Patrick G
PG
Holmboe
Eric S
ES
Horwitz
Ralph I
RI
D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000209:etiology*; D001831:Body Temperature; D016022:Case-Control Studies; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000150:complications* / Q000175:diagnosis
D000431:Ethanol