To Daniel C, Steel Tessa L, Carey Kyle A, Joyce Cara J, Salisbury-Afshar Elizabeth M, Edelson Dana P, Mayampurath Anoop, Churpek Matthew M, Afshar Majid
Department of Medicine, University of Wisconsin-Madison, Madison, WI.
Department of Medicine, University of Washington, Seattle, WA.
Crit Care Explor. 2024 Mar 18;6(3):e1066. doi: 10.1097/CCE.0000000000001066. eCollection 2024 Mar.
Alcohol withdrawal syndrome (AWS) may progress to require high-intensity care. Approaches to identify hospitalized patients with AWS who received higher level of care have not been previously examined. This study aimed to examine the utility of Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) for alcohol scale scores and medication doses for alcohol withdrawal management in identifying patients who received high-intensity care.
A multicenter observational cohort study of hospitalized adults with alcohol withdrawal.
University of Chicago Medical Center and University of Wisconsin Hospital.
Inpatient encounters between November 2008 and February 2022 with a CIWA-Ar score greater than 0 and benzodiazepine or barbiturate administered within the first 24 hours. The primary composite outcome was patients who progressed to high-intensity care (intermediate care or ICU).
None.
Among the 8742 patients included in the study, 37.5% ( = 3280) progressed to high-intensity care. The odds ratio for the composite outcome increased above 1.0 when the CIWA-Ar score was 24. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at this threshold were 0.12 (95% CI, 0.11-0.13), 0.95 (95% CI, 0.94-0.95), 0.58 (95% CI, 0.54-0.61), and 0.64 (95% CI, 0.63-0.65), respectively. The OR increased above 1.0 at a 24-hour lorazepam milligram equivalent dose cutoff of 15 mg. The sensitivity, specificity, PPV, and NPV at this threshold were 0.16 (95% CI, 0.14-0.17), 0.96 (95% CI, 0.95-0.96), 0.68 (95% CI, 0.65-0.72), and 0.65 (95% CI, 0.64-0.66), respectively.
Neither CIWA-Ar scores nor medication dose cutoff points were effective measures for identifying patients with alcohol withdrawal who received high-intensity care. Research studies for examining outcomes in patients who deteriorate with AWS will require better methods for cohort identification.
酒精戒断综合征（AWS）可能会发展到需要高强度护理的程度。此前尚未研究过识别接受更高水平护理的住院AWS患者的方法。本研究旨在探讨修订的临床 institute 酒精戒断评估量表（CIWA-Ar）的酒精量表评分和用于酒精戒断管理的药物剂量在识别接受高强度护理患者方面的效用。
一项针对住院酒精戒断成年患者的多中心观察性队列研究。
芝加哥大学医学中心和威斯康星大学医院。
2008年11月至2022年2月期间住院且CIWA-Ar评分大于0且在最初24小时内使用苯二氮卓类或巴比妥类药物的患者。主要复合结局是进展到高强度护理（中级护理或重症监护病房）的患者。
无。
在纳入研究的8742例患者中，37.5%（n = 3280）进展到高强度护理。当CIWA-Ar评分为24时，复合结局的优势比增加到1.0以上。该阈值下的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为0.12（95%CI，0.11 - 0.13）、0.95（95%CI，0.94 - 0.95）、0.58（95%CI，0.54 - 0.61）和0.64（95%CI，0.63 - 0.65）。当24小时劳拉西泮毫克当量剂量截断值为15mg时，优势比增加到1.0以上。该阈值下的敏感性、特异性、PPV和NPV分别为0.16（95%CI，0.14 - 0.17）、0.96（95%CI，0.95 - 0.96）、0.68（95%CI，0.65 - 0.72）和0.65（95%CI，0.64 - 0.66）。
CIWA-Ar评分和药物剂量截断点均不是识别接受高强度护理的酒精戒断患者的有效措施。研究AWS病情恶化患者结局的研究需要更好的队列识别方法。
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