Sex difference in alcohol withdrawal syndrome: a scoping review of clinical studies

Abstract

BackgroundWe conducted a review of all studies comparing clinical aspects of alcohol withdrawal syndrome (AWS) between men and women.MethodsFive databases (PubMed, Cochrane, EMBASE, Scopus and Clinical Trials) were searched for clinical studies using the keywords “alcohol withdrawal syndrome” or “delirium tremens” limited to “sex” or “gender” or “sex difference” or “gender difference.” The search was conducted on May 19, 2023. Two reviewers selected studies including both male and female patients with AWS, and they compared males and females in type of AWS symptoms, clinical course, complications, and treatment outcome.ResultsThirty-five observational studies were included with a total of 318,730 participants of which 75,346 had AWS. In twenty of the studies, the number of patients presenting with or developing AWS was separated by sex, resulting in a total of 8,159 (12.5%) female patients and a total of 56,928 (87.5%) male patients. Despite inconsistent results, males were more likely than females to develop complicated AWS [delirium tremens (DT) and AW seizures, collective DT in Males vs. females: 1,792 (85.4%) vs. 307 (14.6%), and collective seizures in males vs. females: 294 (78%) vs. 82 (22%)]. The rates of ICU admissions and hospital length of stay did not show sex differences. Although variable across studies, compared to females, males received benzodiazepine treatment at higher frequency and dose. One study reported that the time from first hospitalization for AWS to death was approximately 1.5 years shorter for males and males had higher mortality rate [19.5% (197/1,016)] compared to females [16% (26/163)].ConclusionDespite the significant heterogeneity of the studies selected and the lack of a focus on investigating potential sex differences, this review of clinical studies on AWS suggests that men and women exhibit different AWS manifestations. Large-scale studies focusing specifically on investigating sex difference in AWS are needed.

Biochemical, Hematological, Inflammatory, and Gut Permeability Biomarkers in Patients with Alcohol Withdrawal Syndrome with and without Delirium Tremens

“…Exclusion criteria for patients were as follows: (1) severe, decompensated, or unstable comorbid somatic diseases, traumatic brain injury, alcoholic hallucinosis, alcoholic delusional psychosis, alcoholic encephalopathy, HIV infection, or viral hepatitis; (2) concomitant mental illnesses (according to ICD-10: schizophrenia-F20-F29, epilepsy-G40); (3) mental and behavioral disorders associated with the use of psychoactive substances (F10.1, F11.0−F19.0), dependence on psychoactive substances (except for nicotine and caffeine); (4) history of autoimmune diseases and cancer; (5) acute infectious diseases one month before the study; (6) acute allergic reactions one month before the study; (7) operations and blood transfusions one month before the study; (8) vaccination against any infections within a month before blood collection. The exclusion of the above pathologies is explained by the consideration that many of them are accompanied by an inflammatory response and therefore can significantly affect the analyzed biomarkers.…”

“…AWS is a condition with varied clinical manifestations that resolves within hours or days after cessation of alcohol consumption. The spectrum of clinical manifestations of AWS ranges from anxiety, sweating, and dizziness to severe conditions including Delirium Tremens (DT), alcoholic hallucinosis, alcoholic delusional psychosis, and alcoholic encephalopathies [4][5][6]. DT is a dangerous manifestation of AWS sometimes leading to the death of the patient.…”