Bates Ruth E, Leung Jonathan G, Morgan Robert J, Fischer Karen M, Philbrick Kemuel L, Kung Simon
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Pharmacy, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 19;4(5):542-549. doi: 10.1016/j.mayocpiqo.2020.06.002. eCollection 2020 Oct.
To evaluate the efficacy and safety of a fixed-dose gabapentin taper protocol for alcohol withdrawal in hospitalized patients.
We retrospectively identified patients admitted to the hospital from January 1, 2016, to April 30, 2018, for alcohol withdrawal syndrome. Based on the treatment that patients received, they were divided into the gabapentin, benzodiazepine, and combination treatment groups. The primary outcome was length of stay, defined as time from admission to either discharge or 36 hours with Clinical Institute Withdrawal Assessment (CIWA) score less than 10. Inverse probability of treatment weight was used to account for differences in baseline characteristics between groups.
A total of 443 patients met criteria for inclusion (128, 253, and 62 patients in the gabapentin, benzodiazepine, and combination groups, respectively). Baseline characteristics were similar among all groups. The median gabapentin group length of stay was 4.0 hours shorter than the benzodiazepine group (=.012). Maximum CIWA score was 2.2 points lower in the gabapentin group (=.003). No statistical differences were noted among safety outcomes, including incidence of seizure, intensive care unit transfer, or delirium tremens. Results were not statistically altered by inverse probability of treatment weight analysis.
A fixed-dose gabapentin taper protocol appears to be an effective and safe alternative to CIWA-driven benzodiazepines in patients hospitalized with alcohol withdrawal syndrome, though further research is necessary to define the potential subpopulations that benefit most.
评估固定剂量加巴喷丁递减方案用于住院患者酒精戒断的疗效和安全性。
我们回顾性确定了2016年1月1日至2018年4月30日因酒精戒断综合征入院的患者。根据患者接受的治疗，将他们分为加巴喷丁组、苯二氮䓬类药物组和联合治疗组。主要结局为住院时间，定义为从入院到出院或临床研究所戒断评估（CIWA）评分低于10分达36小时的时间。采用治疗权重的逆概率来解释组间基线特征的差异。
共有443例患者符合纳入标准（加巴喷丁组、苯二氮䓬类药物组和联合组分别有128例、253例和62例患者）。所有组的基线特征相似。加巴喷丁组的中位住院时间比苯二氮䓬类药物组短4.0小时（P = 0.012）。加巴喷丁组的最高CIWA评分低2.2分（P = 0.003）。在包括癫痫发作、转入重症监护病房或震颤谵妄发生率在内的安全性结局方面未观察到统计学差异。治疗权重的逆概率分析未使结果发生统计学改变。
对于因酒精戒断综合征住院的患者，固定剂量加巴喷丁递减方案似乎是CIWA驱动的苯二氮䓬类药物的一种有效且安全的替代方案，不过需要进一步研究以确定最受益的潜在亚组人群。
