title: Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures.
abstract: OBJECTIVE
  In several studies, possible risk factors/predictors for severe alcohol withdrawal syndrome (AWS), i.e. delirium tremens (DT) and/or seizures, have been investigated. We have recently observed that low blood platelet count could be such a risk factor/predictor. We therefore investigated whether such an association could be found using a large number of alcohol-dependent individuals (n = 334).
  
  
  METHODS
  This study is a retrospectively conducted cohort study based on data from female and male patients (>20 years of age), consecutively admitted to an alcohol treatment unit. The individuals had to fulfil the discharge diagnoses alcohol dependence and alcohol withdrawal syndrome according to DSM-IV.
  
  
  RESULTS
  During the treatment period, 3% of the patients developed DT, 2% seizures and none had co-occurrence of both conditions. Among those with DT, a higher proportion had thrombocytopenia. Those with seizures had lower blood platelet count and a higher proportion of them had thrombocytopenia. The sensitivity and specificity of thrombocytopenia for the development of DT during the treatment period was 70% and 69%, respectively. The positive predictive value (PPV) was 6% and the negative predictive value (NPV) was 99%. For the development of seizures, the figure for sensitivity was 75% and for specificity 69%. The figures for PPV and NPV were similar as those for the development of DT.
  
  
  CONCLUSIONS
  Thrombocytopenia is more frequent in patients who develop severe AWS (DT or seizures). The findings, including the high NPV of thrombocytopenia, must be interpreted with caution due to the small number of patients who developed AWS. Further studies replicating the present finding are therefore needed before the clinical usefulness can be considered.
authors.affiliation: Institute of Clinical Neuroscience, Section of Psychiatry, University of Gothenburg, Göteborg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Berggren
authors.forename: Claudia
authors.initials: C
authors.lastname: Fahlke
authors.forename: Kristina J
authors.initials: KJ
authors.lastname: Berglund
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.forename: Jan
authors.initials: J
authors.lastname: Balldin
mesh_terms: D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000453:epidemiology / Q000209:etiology*; D001772:Blood Cell Count; D002492:Central Nervous System Depressants / Q000009:adverse effects*; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*; D012737:Sex Factors; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000209:etiology*; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D006454:Hemoglobins; D000431:Ethanol