Vigouroux Aliénor, Garret Charlotte, Lascarrou Jean-Baptiste, Martin Maëlle, Miailhe Arnaud-Félix, Lemarié Jérémie, Dupeyrat Julien, Zambon Olivier, Seguin Amélie, Reignier Jean, Canet Emmanuel
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France.
PLoS One. 2021 Dec 20;16(12):e0261443. doi: 10.1371/journal.pone.0261443. eCollection 2021.
Alcohol withdrawal syndrome (AWS) is a common condition in hospitalized patients, yet its epidemiology in the ICU remains poorly characterized.
Retrospective cohort of patients admitted to the Nantes University Hospital ICU between January 1, 2017, and December 31, 2019, and coded for AWS using ICD-10 criteria. The objective of the study was to identify factors associated with complicated hospital stay defined as ICU length of stay ≥7 days or hospital mortality.
Among 5,641 patients admitted to the ICU during the study period, 246 (4.4%) were coded as having AWS. Among them, 42 had exclusion criteria and 204 were included in the study. The three main reasons for ICU admission were sepsis (29.9%), altered consciousness (29.4%), and seizures (24%). At ICU admission, median Cushman's score was 6 [4-9] and median SOFA score was 3 [2-6]. Delirium tremens occurred in half the patients, seizures in one fifth and pneumonia in one third. Overall, 48% of patients developed complicated hospital stay, of whom 92.8% stayed in the ICU for ≥7 days, 36.7% received MV for ≥7 days, and 16.3% died during hospital stay. By multivariable analysis, two factors were associated with complicated hospital stay: a higher number of organ dysfunctions at ICU admission was associated with a higher risk of complicated hospital stay (OR, 1.18; 95CI, 1.05-1.32, P = 0.005), whereas ICU admission for seizures was associated with a lower risk of complicated hospital stay (OR, 0.14; 95%CI, 0.026-0.80; P = 0.026).
AWS in ICU patients chiefly affects young adults and is often associated with additional factors such as sepsis, trauma, or surgery. Half the patients experienced an extended ICU stay or death during the hospital stay. The likelihood of developing complicated hospital stay relied on the reason for ICU admission and the number of organ dysfunctions at ICU admission.
酒精戒断综合征（AWS）在住院患者中很常见，但其在重症监护病房（ICU）的流行病学特征仍不清楚。
对2017年1月1日至2019年12月31日入住南特大学医院ICU的患者进行回顾性队列研究，并根据国际疾病分类第十版（ICD-10）标准对AWS进行编码。本研究的目的是确定与住院复杂情况相关的因素，住院复杂情况定义为ICU住院时间≥7天或医院死亡率。
在研究期间入住ICU的5641例患者中，246例（4.4%）被编码为患有AWS。其中，42例有排除标准，204例纳入研究。入住ICU的三个主要原因是脓毒症（29.9%）、意识改变（29.4%）和癫痫发作（24%）。入住ICU时，库什曼评分中位数为6[4-9]，序贯器官衰竭评估（SOFA）评分中位数为3[2-6]。半数患者发生震颤谵妄，五分之一患者发生癫痫发作，三分之一患者发生肺炎。总体而言，48%的患者出现住院复杂情况，其中92.8%在ICU停留≥7天，36.7%接受机械通气≥7天，16.3%在住院期间死亡。通过多变量分析，两个因素与住院复杂情况相关：入住ICU时器官功能障碍数量较多与住院复杂情况风险较高相关（比值比[OR]，1.18；95%置信区间[CI]，1.05-1.32，P=0.005），而因癫痫发作入住ICU与住院复杂情况风险较低相关（OR，0.14；95%CI，0.026-0.80；P=0.026）。
ICU患者的AWS主要影响年轻人，且常与脓毒症、创伤或手术等其他因素相关。半数患者在住院期间经历了延长的ICU停留时间或死亡。发生住院复杂情况的可能性取决于入住ICU的原因以及入住ICU时器官功能障碍的数量。
