The maximum alcohol withdrawal syndrome score associates with worse clinical outcomes—A retrospective cohort study

• Published in: Drug and alcohol dependence Vol. 205; p. 107708
• Main Authors: Griessbach, Alexandra N., Mueller, Beatrice U., Battegay, Edouard, Beeler, Patrick E.
• Format: Journal Article
• Language: English
• Published: Lausanne Elsevier B.V 01.12.2019; Elsevier Science Ltd
• Subjects: Alcohol use; Alcohol use disorder (AUD); Alcohol withdrawal; Alcohol withdrawal syndrome (AWS); Alcoholism; Assessments; Clinical outcomes; Cohort analysis; In-hospital mortality; Length of stay; Length of stay (LOS); Mortality; Multimorbidity; Regression analysis; Risk assessment; Severity; Wetterling scale (AWS scale); Wetterling scale (AWS scale); In-hospital mortality; Length of stay (LOS); Alcohol use disorder (AUD); Alcohol withdrawal syndrome (AWS); Multimorbidity
• DOI: 10.1016/j.drugalcdep.2019.107708
• ISSN: 0376-8716

•Maximum alcohol withdrawal syndrome (AWS) score is higher in multimorbid patients.•Higher maximum AWS scores associate with worse outcomes (length of stay/mortality).•Those findings are reproducible already within the first 3 days of withdrawal.•Such a 3-day tool may help to assess risk and adjust patient treatment early on. The Wetterling alcohol withdrawal syndrome (AWS) scale determines withdrawal severity and guides treatment. We investigated associations between maximum AWS scores and clinical outcomes. This retrospective cohort study considered AWS assessments measured from 8/2015-8/2017. We used multivariable linear and logistic regression to analyze associations between the maximum score and increased length of stay (LOS) and in-hospital mortality, respectively. Firstly, we investigated the maximum score of all AWS assessments any time during the stay, secondly, the maximum measured only within the first 3 days of withdrawal. A total of 2,464 hospital stays showed that, patients with “mild” (<6), “moderate” (6–9), and “severe” (>9) maximum scores had median LOS of 5.93, 9.35, 14.71 days, mortality was 1.7%, 4.8%, 8.0%, respectively. Regression showed that a higher maximum score was independently associated with increased LOS and mortality (both p < 0.001). Based on the maximum AWS score within the first 3 days, the median LOS was 6.18, 9.00, 12.89 days, mortality was 2.2%, 3.6%, 7.6%, respectively. A higher maximum score in the first 3 days was independently associated with increased LOS (p = 0.036) and mortality (p = 0.001). Severe maximum AWS scores within 3 days of withdrawal had an odds ratio of 2.53 (95% CI: 1.27, 4.82; p = 0.0060) for in-hospital death. Maximum AWS scores associate independently with increased LOS and in-hospital mortality. This association is reproducible within the first 3 days of withdrawal. Development of such a 3-day tool could help clinicians assess the risk of worse clinical outcomes early on and adjust care accordingly.