Predictors of Mortality in Patients with Delirium Tremens

Abstract

Objectives: The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT). Methods:The authors conducted a 1:1 gender-and age-matched case-control study of patients hospitalized for DT. Using McNemar chi-square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.Results: Thirty-five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (±standard deviation [SD]) age of 51.7 (±7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively). Conclusions:The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.ACADEMIC EMERGENCY MEDICINE 2008; 15:788-790 ª

Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures

“…Delirium tremens occurs in a small proportion of patients with alcohol withdrawal syndrome; nevertheless, early identification of high-risk patients is important for clinical management by appropriate detection and prompt treatment and prevention of unexpected accident due to agitation [5]. In addition, delayed identification of DT is potentially associated with serious morbidity and mortality resulting from hyperthermia, cardiac arrhythmia, complications of seizures, or concomitant medical disorders [6].…”

Recognition and Management of Withdrawal Delirium (Delirium Tremens)

“…7,9,11,13 Death usually results from hyperthermia, cardiac arrhythmias, complications of withdrawal seizures, or concomitant medical disorders. 14,15 Delirium during alcohol withdrawal is predicted by the following: CIWA-Ar scores above 15 (especially in association with a systolic blood pressure >150 mm Hg or a pulse rate >100 beats per minute), recent withdrawal seizures (seen in 20% of persons with delirium), prior withdrawal delirium or seizures, older age, recent misuse of other depressant agents, and concomitant medical problems. 7,10,11,13,16,17 The latter include electrolyte abnormalities (e.g., low levels of potassium, magnesium, or both), low platelet counts, and respiratory, cardiac, or gastrointestinal disease.…”

Risk factors for lethal outcome in patients with delirium tremens - psychiatrist's perspective: a nested case-control study

“…Over the last few decades, the mortality rate for patients with DT has fallen from 35% to 2%, and this has been largely attributed to improved diagnostic and pharmacological measures [2,6-11]. Several studies have identified risk factors for the occurrence of DT [5,12-18], but there has been little research into the risk factors for mortality among patients with DT [3,6,10,18,19]. The factors that predict a fatal outcome in patients with DT remain unclear, and DT is still categorized as an emergency [2,3,5,20].…”

“…Several studies have identified risk factors for the occurrence of DT [5,12-18], but there has been little research into the risk factors for mortality among patients with DT [3,6,10,18,19]. The factors that predict a fatal outcome in patients with DT remain unclear, and DT is still categorized as an emergency [2,3,5,20]. The early recognition of risk factors for DT mortality in patients will facilitate the introduction of preventative measures to decrease the likelihood of a fatal outcome [3,21].…”