title: Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital.
abstract: OBJECTIVE
  To investigate the clinical variables associated with the risk of dying and the causes of death during the course of alcoholic withdrawal syndrome (AWS) in a general hospital.
  
  
  METHODS
  Cohort study of AWS patients admitted to Xeral Hospital in Lugo, Spain between 1987 and 2003. The characteristics of patients who died were contrasted with those who survived. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of the syndrome and its complications were all recorded.
  
  
  RESULTS
  There were 539 episodes of hospitalization for AWS in 436 patients (mean age 45.0, SD 12.0, 91.3% males), 71.1% of whom presented with delirium tremens. A total of 29 patients died, yielding a 6.6% mortality rate (95% confidence interval, CI: 4.2-9.1%). Eighteen patients (62%) died after being admitted to the intensive care unit (ICU). The following independent variables were associated with the risk of dying in a multivariate logistic regression model: cirrhosis [odds ratio (OR) 4.8 (95% CI 1.5-14.6), P = 0.006]; presenting with delirium tremens at diagnosis [OR 3.5 (95% CI 1.3-8.9), P = 0.008]; the existence of an underlying chronic pathology other than liver disease [OR 2.5 (95% CI 1-6.1), P = 0.01]; and the need for orotracheal intubation [OR 2.9 (95% CI 1.1-7.9), P = 0.03], especially if pneumonia requiring ICU is added [OR 8 (95% CI 3-21.3), P < 0.001]. Receiver operating characteristic analysis revealed an area under the curve of 0.818 (95% CI 0.742-0.894).
  
  
  CONCLUSIONS
  The factors determining survival after admission to a general hospital for alcoholic withdrawal syndrome depend on the intensity of clinical manifestations (delirium tremens, ICU, orotracheal intubation) and the presence of associated comorbidity.
authors.affiliation: Department of Internal Medicine, Xeral-Calde Hospital, SERGAS, Lugo, Spain. rafael.monte.secades@sergas.es
authors.forename: R
authors.initials: R
authors.lastname: Monte
authors.forename: R
authors.initials: R
authors.lastname: Rabuñal
authors.forename: E
authors.initials: E
authors.lastname: Casariego
authors.forename: H
authors.initials: H
authors.lastname: López-Agreda
authors.forename: A
authors.initials: A
authors.lastname: Mateos
authors.forename: S
authors.initials: S
authors.lastname: Pértega
mesh_terms: D000328:Adult; D000430:Alcohol Withdrawal Delirium / Q000401:mortality*; D020270:Alcohol Withdrawal Seizures / Q000401:mortality*; D000437:Alcoholism / Q000401:mortality* / Q000534:rehabilitation*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate