Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures.
BACKGROUND
Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures.


METHODS
Patients who visited the emergency department with acute seizures were included in the study when alcohol withdrawal was the only or the strongest precipitating factor for seizures. All patients were carefully observed for at least 48 hours in the intensive care unit after the initial assessment to closely monitor vital signs and development of DT. Clinical and laboratory findings were analyzed for predicting the development of DT.


RESULTS
Of the 97 patients (82 males; mean age, 48.6 ± 13.3 years) with alcohol withdrawal seizures, 34 (35.1%) developed DT. Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine were associated with the subsequent development of DT. Low platelet count and high blood level of homocysteine were independent risk factors with high diagnostic sensitivity and specificity for the development of DT.


CONCLUSIONS
The study indicated that some easily determined parameters are potential clinical predictors for the development of DT in patients with alcohol withdrawal seizures. These findings would be helpful in clinical identification and management patients at high risk for DT.
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea. Electronic address: drdongwkim@gmail.com.
Dong Wook
DW
Kim
Department of Neurology, National Medical Center, Seoul, Korea. Electronic address: crespy97@gmail.com.
Hyun Kyung
HK
Kim
Department of Neurology, Inha University Hospital, Incheon, Korea. Electronic address: alchemist021@gmail.com.
Eun-Kee
EK
Bae
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea. Electronic address: 20110383@kuh.ac.kr.
So-Hee
SH
Park
Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea. Electronic address: neukim@duih.org.
Kwang Ki
KK
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000430:Alcohol Withdrawal Delirium / Q000097:blood / Q000175:diagnosis*; D020270:Alcohol Withdrawal Seizures / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
D015415:Biomarkers