Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal.
Alcohol Alcohol. 2012 Nov-Dec;47(6):702-10. doi: 10.1093/alcalc/ags097. Epub 2012 Sep 17.
To identify prognostic factors to outpatient alcohol treatment on admission as well as during the treatment period.
A cohort study of n = 209 alcoholic patients (DSM-IV) during 6 months of outpatient treatment. Eight medical doctors from two hospitals were involved. Co-responsible participation in treatment was a necessary condition. At admission, we documented socio demographic factors, use of other drugs and severity of alcohol consumption. During the 6 months, we observed medication for prevention of alcohol relapse [disulfiram (DIS), acamprosate], number of sessions with the doctor, number of phases of the consultation and medication for depression. Primary outcome variables were time to first heavy relapse and abstinence of heavy alcohol consumption. These were measured with Timeline Followback. Five or more alcohol units of 10 g in one relapse day were considered heavy relapse.
The patients were 84% males, with 41 years median age; the median alcohol consumption was 192 g per day with a median duration of 13 years of heavy consumption. The median education was 6 years with 61% of the patients from lower socio-economic levels. The Kaplan-Meier heavy relapse rate at 6 months was 23%. On admission to treatment, female gender, lower socio-economic levels, cocaine use, >20 years of consumption, gamma glutamyl transferase values above normal and five or more alcohol-related problems on the Alcohol-Related Problem Questionnaire predicted worse outcomes. Having a full-time job and shorter abstinence time before treatment (until 7 days) predicted better outcomes. During the 6 months, we found that DIS for <120 days was a prognostic factor of worse outcomes. DIS for at least 120 days, >50% of adherence to consultations and more than two phases on each consultation predicted better outcomes. The combined sensitivity and specificity for DIS for at least 120 days, >50% of adherence to consultations and more than two phases on consultation regarding abstinence from heavy relapse were respectively 100 and 71%.
During 6 months of outpatient treatment, longer adherence to DIS and consultations as well as more phases in a consultation involving necessarily a co-responsible predict a good outcome independently of the patient features at admission.
确定门诊酒精治疗入院时和治疗期间的预后因素。
对 209 名符合 DSM-IV 标准的酒精患者进行了 6 个月的门诊治疗的队列研究。两家医院的 8 名医生参与其中。共同负责参与治疗是必要条件。入院时，我们记录了社会人口统计学因素、其他药物的使用情况和酒精摄入量的严重程度。在 6 个月期间，我们观察了预防酒精复发的药物[双硫仑（DIS）、安非他酮]、与医生就诊的次数、就诊阶段的数量和治疗抑郁的药物。主要结局变量是首次重度复发和重度饮酒戒除的时间。这些是通过时间线回溯法测量的。一次复发日中 5 个或更多 10 克酒精单位被认为是重度复发。
患者中 84%为男性，中位年龄为 41 岁；中位酒精摄入量为每天 192 克，重度饮酒中位持续时间为 13 年。中位教育程度为 6 年，61%的患者来自较低的社会经济水平。6 个月时的 Kaplan-Meier 重度复发率为 23%。治疗入院时，女性、较低的社会经济水平、可卡因使用、>20 年的饮酒史、γ-谷氨酰转移酶值高于正常值和酒精相关问题问卷上的 5 个或更多酒精相关问题预测预后较差。有全职工作和治疗前（直到 7 天）的更长时间的戒酒时间预测预后更好。在 6 个月期间，我们发现 DIS 少于 120 天是预后不良的预测因素。DIS 至少 120 天、>50%的就诊依从性和每次就诊的两个以上阶段预测预后较好。关于 DIS 至少 120 天、>50%的就诊依从性和每次就诊两个以上阶段与重度复发戒酒的联合灵敏度和特异性分别为 100%和 71%。
在 6 个月的门诊治疗期间，更长时间的 DIS 和就诊依从性以及更多阶段的就诊，必然涉及共同负责，可独立预测预后良好，而与入院时的患者特征无关。
