Findley John K, Park Lawrence T, Siefert Caleb J, Chiou Grace J, Lancaster Robert T, Demoya Marc, Gervasini Alice, Velmahos George C
Division of Trauma, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Trauma. 2010 Jul;69(1):199-201. doi: 10.1097/TA.0b013e3181bee583.
Delirium tremens (DT) in trauma patients is associated with significant morbidity and mortality. Short interview tools have been used to determine the risk of DT but require an alert, compliant patient and a motivated physician. The mean corpuscular volume (MCV) and aspartate aminotransferase (AST) levels are parts of routine laboratory testing, influenced by excessive alcohol consumption, and may serve as predictors of DT. This study examines the predictive ability of these two readily available biological markers.
The records of 423 consecutive trauma patients who presented to a Level I trauma center with a positive toxicology screen for alcohol were reviewed. The outcome variable was DT, as defined by the presence of tremor, diaphoresis, autonomic instability, and hallucinations. The positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR) of the admission MCV and AST values were calculated for the prediction of DT.
Of the 336 patients who met the criteria for study participation, 110 were diagnosed with DT due to alcohol withdrawal. When the admission MCV and AST were normal, only 3 patients (3.8%) developed DT. The NPV, PPV, and LR with two normal values together were 58.2%, 3.8%, and 0.080, respectively. When both were abnormal, 72 patients (64.3%) developed DT. The NPV, PPV, and LR with two abnormal values together were 83%, 64.3%, and 3.698, respectively.
Normal admission MCV and AST values in intoxicated trauma patients nearly exclude the development of DT.
创伤患者的震颤谵妄（DT）与显著的发病率和死亡率相关。简短的访谈工具已被用于确定DT的风险，但需要患者清醒且配合，以及医生积极主动。平均红细胞体积（MCV）和天冬氨酸转氨酶（AST）水平是常规实验室检测的一部分，受过量饮酒影响，可能作为DT的预测指标。本研究考察这两种易于获得的生物学标志物的预测能力。
回顾了423例连续入住一级创伤中心且酒精毒理学筛查呈阳性的创伤患者的记录。结局变量为DT，定义为存在震颤、发汗、自主神经不稳定和幻觉。计算入院时MCV和AST值对DT预测的阳性预测值（PPV）、阴性预测值（NPV）和似然比（LR）。
在符合研究参与标准的336例患者中，110例因酒精戒断被诊断为DT。入院时MCV和AST正常的患者中，只有3例（3.8%）发生DT。两项值均正常时的NPV、PPV和LR分别为58.2%、3.8%和0.080。两项值均异常时，72例患者（64.3%）发生DT。两项值均异常时的NPV、PPV和LR分别为83%、64.3%和3.698。
醉酒创伤患者入院时MCV和AST值正常几乎可排除DT的发生。
