Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK.
Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK.
J Transl Med. 2019 Nov 21;17(1):384. doi: 10.1186/s12967-019-02141-w.
Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS.
Patients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded.
The majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275-675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05).
The prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.
酒精戒断综合征（AWS）通常采用维生素 B 治疗。然而，很少有研究检查硫胺素状态与结局之间的关系。本研究的目的是检查 AWS 患者中硫胺素和镁状态之间的关系。
从急诊科就诊的 AWS 患者中招募了前瞻性观察性研究。采集血样以测量全血硫胺素二磷酸（TDP）和血清镁浓度。还进行了常规生化和血液学检测。格拉斯哥改良酒精戒断评分（GMAWS）用于评估 AWS 的严重程度。记录癫痫发作史和当前用药情况。
大多数患者（99%）的全血 TDP 浓度在参考区间内/以上（275-675ng/gHb），并已开处方使用硫胺素（70%）。相比之下，大多数患者（60%）的血清镁浓度较低（<0.75mmol/L），并且未开处方使用镁（93%）。大多数患者（66%）的血浆乳酸浓度高于 2.0mmol/L。在 1 年时，13 名 AWS 患者死亡，死亡率为 11%。男性（p<0.05）、BMI<20kg/m（p<0.01）、GMAWS 最大值≥4（p<0.05）、血浆乳酸升高（p<0.01）、白蛋白降低（p<0.05）和血清 CRP 升高（p<0.05）与 1 年死亡率增加相关。此外，入组时和下一次入院时血清镁低与更高的 1 年死亡率相关，分别为 84%和 100%（均 p<0.05）。
循环中硫胺素浓度低的发生率罕见，AWS 患者经常开处方使用硫胺素。相比之下，血清镁浓度低很常见，且未开处方使用镁。低血清镁与更严重的 AWS 相关，并增加 1 年死亡率。
