Mennecier D, Thomas M, Arvers P, Corberand D, Sinayoko L, Bonnefoy S, Harnois F, Thiolet C
Service d'Hépatogastroentérologie, Service de Pathologie Digestive, Hôpital d'Instruction des Armées Bégin, St-Mandé, France.
Gastroenterol Clin Biol. 2008 Aug-Sep;32(8-9):792-7. doi: 10.1016/j.gcb.2008.06.004. Epub 2008 Aug 30.
In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management.
Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score.
The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6+/-10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p=0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1+/-44.4 UI/L versus 78.4+/-11.8 UI/L; p=0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8. In conclusion, severe alcohol withdrawal (Cushman score>or=8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.
在一个肝病和胃肠病科，有相当数量的患者因酒精戒断而住院。这项回顾性研究的目的是确定严重或复杂酒精戒断的预测因素，以改善患者管理。
在2002年6月至2005年6月期间，182例根据DSM-IV分类诊断为酒精依赖的患者纳入本研究。所有患者均采用独特的酒精戒断管理方案。在第1、2和3天记录库什曼评分，以评估酒精戒断的严重程度。我们寻找流行病学、临床和生物学数据与库什曼评分之间的相关性。
研究人群包括136例（74.7%）男性和46例（25.3%）女性，平均年龄47.6±10.1岁。118例患者（64.8%）来自专科门诊，64例患者（35.2%）来自急诊科。第1、2和3天的库什曼评分均值和中位数分别为：5.1和5；3.9和4；2.3和2。分别有20例患者（11.0%）和5例患者（2.7%）的评分大于或等于8以及大于12。急诊科转诊的患者在第1天库什曼评分大于或等于8的比例显著高于专科门诊转诊的患者（p=0.002）。评分大于或等于8的患者第1天的平均丙氨酸转氨酶水平显著高于评分小于8的患者（112.1±44.4 UI/L对78.4±11.8 UI/L；p=0.046）。通过急诊科转诊以及丙氨酸转氨酶水平高于正常范围上限1.5倍是库什曼评分大于或等于8的独立预测因素。总之，严重酒精戒断（库什曼评分≥8）与在急诊科的初始管理以及血清丙氨酸转氨酶水平高于正常范围上限1.5倍显著相关。应监测这些预测因素，以便适当调整治疗方案。
