Risk factors for the development of delirium in alcohol dependence syndrome: Clinical and neurobiological implications

Abstract

Introduction:Alcohol withdrawal delirium (AWD) or delirium tremens (DT) is associated with severe complications and high mortality. Prospectively identifying patients with increased risk of developing DT would have important preventive and therapeutic implications. Thus, the present study aimed to identify clinical risk factors predicting the development of DT.Materials and Methods:The study was a cross-sectional quasi-experimental one with equivalent control group, conducted at a tertiary hospital from August 2014 to May 2015. Forty adult male inpatients, diagnosed with DT, were compared with forty age- and sex-matched inpatients in alcohol withdrawal state without delirium. Assessments were done using confusion assessment method, Clinical Institute Withdrawal Assessment of Alcohol Scale, and Mini–Mental Status Examination. For group comparisons, Pearson's Chi-square test and independent sample t-test were used; logistic regression was applied to identify predictors followed by receiver operating characteristic curve analysis.Results:Heavy drinking (P = 0.005; odds ratio [OR]: 1.17, confidence interval [CI]: 1.05–1.31), continuous pattern of drinking (P = 0.027; OR: 4.67, CI: 1.19–18.33), past history of delirium (P = 0.009; OR: 552.8, CI: 4.88–625.7), alcohol-induced psychosis (P = 0.002; OR: 74.6, CI: 4.68–1190), and presence of cognitive deficits (P = 0.044; OR: 12.5, CI: 1.07–147.3) emerged as strong predictors of AWD.Conclusion:The risk factors found can be easily evaluated in a clinical setting for physicians to readily identify patients at risk for developing DT and plan intensive therapies for them. At a neurobiological level, patients with preexisting brain neurotransmitter disturbances are at greater risk for developing DT.

Prevalence of alcohol dependence syndrome cases with and without delirium during the first phase of lockdown in Telangana

“…18 (Ferguson et al (1996)). We found a positive correlation between the severity of alcohol dependence and withdrawal delirium (R = 0.260 and P = 0.000*) -implies that as the severity of dependence increases, the probability of delirium presentation also increases, which is in line with a study by Sarkar et al 14 finding of continuous drinking as a risk factor for delirium. Most of the samples clustered at higher values of SADQ in those presented with delirium.…”

“…12 When compared, the impact of sociodemographic factors between with and without delirium, no significant differences. [14][15][16] found, except gender. Among total of 667 patients, 216 males and 50 females presented with delirium.…”

“…18 A study by Sarkar et al found a positive correlation between the number of drinks per day with delirium (t=-2.99, P-0.004). 14…”

Cognitive Dysfunction and Survival in Hospitalized Patients with Delirium: A 12-Month Prospective Cohort Study

“…In line with our results, Mitchell et al (2017) showed that delirium in hospital had an as-sociation with all-cause one-year mortality following hip fracture in older cases with no dementia (31). Also, similar to previous studies, the other underlying factors can affect mortality rate including cancer (32), hepatic (33), renal (34), and hematologic diseases (35,36).…”

Delirium tremens: early diagnosis and intensive care guidelines. Review

“…Интенсивная терапия алкогольного делирия должна проводиться в условиях отделения интенсивной терапии. Ее необходимо начинать незамедлительно, как только диагностирована белая горячка [45]. Основными задачами являются: снижение/устранение возбуждения и других симптомов делирия, диагностика и лечение сопутствующих заболеваний, адекватное, протокольное лечение ААС [18,55].…”