Hawa Fadi, Gilbert Linsey, Gilbert Benjamin, Hereford Vanessa, Hawa Aya, Al Hillan Alsadiq, Weiner Mark, Albright Jeremy, Scheidel Caleb, Al-Sous Ola
Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA.
Internal Medicine/Palliative Care, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA.
Cureus. 2021 Feb 11;13(2):e13282. doi: 10.7759/cureus.13282.
Introduction Annually, 500,000 episodes of alcohol withdrawal syndrome (AWS) are severe enough to require clinical attention. A symptom-triggered lorazepam regimen remains the standard of care for the management of hospitalized AWS patients. However, phenobarbital has also been shown to be an effective adjunctive therapy for severe AWS, reducing benzodiazepine use in the emergency department (ED) and the intensive care unit (ICU). The purpose of this study is to compare hospital length of stay (LOS) for AWS patients using phenobarbital-based versus lorazepam-based treatment protocols as monotherapy for management of AWS on general medical units. Methods This is a retrospective cohort study over a two-year period (March, 2016 to March, 2018), conducted at three hospitals within the St. Joseph Mercy Health System. We included 606 patients with a primary diagnosis of AWS or alcohol intoxication who met our inclusion criteria (543 in the lorazepam cohort and 63 in the phenobarbital cohort). Adjusted comparisons were done using propensity scoring methods. Hospital LOS was set as the primary outcome. Secondary outcomes included all-cause 30-day readmission, alcohol-related 30-day readmission, 30-day ED visits after discharge, and need for ICU transfer during hospital stay. Results Patients who received phenobarbital had a statistically significant shorter hospital LOS as compared to patients who received lorazepam (2.8 versus 3.6 days, P < 0.001). Furthermore, the phenobarbital treatment group had statistically significant lower rates of all-cause 30-day readmission (11.11% versus 14.18%, P = 0.020) and 30-day ED visits after discharge (11.11% versus 18.6%, P = 0.015). No statistical significance was detected for alcohol-related 30-day readmission and the need for ICU transfer between the treatment groups. Conclusion This study suggests that phenobarbital may be a reasonable alternative to lorazepam in the management of AWS patients admitted to general medical units. Larger scale, well-executed, and adequately powered prospective studies and randomized controlled trials are needed to corroborate these findings.
引言 每年有50万例酒精戒断综合征（AWS）严重到需要临床关注。症状触发的劳拉西泮治疗方案仍然是住院AWS患者管理的标准治疗方法。然而，苯巴比妥也已被证明是治疗严重AWS的有效辅助疗法，可减少急诊科（ED）和重症监护病房（ICU）中苯二氮卓类药物的使用。本研究的目的是比较在普通内科病房使用基于苯巴比妥与基于劳拉西泮的治疗方案作为单药治疗AWS的患者的住院时间（LOS）。方法 这是一项为期两年（2016年3月至2018年3月）的回顾性队列研究，在圣约瑟夫慈善医疗系统内的三家医院进行。我们纳入了606例初步诊断为AWS或酒精中毒且符合我们纳入标准的患者（劳拉西泮队列中有543例，苯巴比妥队列中有63例）。使用倾向评分方法进行调整后的比较。将住院LOS设定为主要结局。次要结局包括全因30天再入院、酒精相关30天再入院、出院后30天内的ED就诊以及住院期间转入ICU的需求。结果 与接受劳拉西泮治疗的患者相比，接受苯巴比妥治疗的患者的住院LOS在统计学上显著更短（2.8天对3.6天，P<0.001）。此外，苯巴比妥治疗组的全因30天再入院率（11.11%对14.18%，P = 0.020）和出院后30天内的ED就诊率（11.11%对18.6%，P = 0.015）在统计学上显著更低。在治疗组之间，酒精相关30天再入院率和转入ICU的需求未检测到统计学显著性差异。结论 本研究表明，在普通内科病房收治的AWS患者的管理中，苯巴比妥可能是劳拉西泮的合理替代药物。需要更大规模、执行良好且有足够效力的前瞻性研究和随机对照试验来证实这些发现。
