Treatment variability and its relationships to outcomes among patients with Wernicke's encephalopathy: A multicenter retrospective study

Background: Despite guidelines and recommendations, Wernicke's encephalopathy (WE) treatment lacks evidence, leading to clinical practice variability.Aims: Given the overall lack of information on thiamine use for WE treatment, we analyzed data from a large, well-characterized multicenter sample of patients with WE, examining thiamine dosages; factors associated with the use of different doses, frequencies, and routes; and the influence of differences in thiamine treatment on the outcome.Methods: This retrospective study was conducted with data from 443 patients from 21 centers obtained from a nationwide registry of the Spanish Society of Internal Medicine (from 2000 to 2012). Discharge codes and Caine criteria were applied for WE diagnosis, and treatment-related (thiamine dosage, frequency, and route of administration) demographic, clinical, and outcome variables were analyzed.Results: We found marked variability in WE treatment and a low rate of high-dose intravenous thiamine administration. Seventy-eight patients out of 373 (20.9%) received > 300 mg/day of thiamine as initial dose. Patients fulfilling the Caine criteria or presenting with the classic WE triad more frequently received parenteral treatment. Delayed diagnosis (after 24 h hospitalization), the fulfillment of more than two Caine criteria at diagnosis, mental status alterations, and folic acid deficiency were associated significantly with the lack of complete recovery. Malnutrition, reduced consciousness, folic acid deficiency, and the lack of timely thiamine treatment were risk factors for mortality.Conclusions: Our results clearly show extreme variability in thiamine dosages and routes used in the management of WE. Measures should be implemented to ensure adherence to current guidelines and to correct potential nutritional deficits in patients with alcohol use disorders or other risk factors for WE

Epidemiología del síndrome de abstinencia alcohólica en la Comunidad Autónoma de Galicia

We define alcohol withdrawal syndrome (AWS) as a group of symptoms that may occur after decrease or suddenly stopping the alcohol intake, including headache, sweating, tremor, insomnia, nervousness, nausea, vomiting, visual and auditive hallucinations, or convulsions. Some patients evolve to delirium tremens. Objective: To determine the prevalence and epidemiologic characteristics of AWS in Galicia (Spain), an autonomic community with high prevalence of risk drinkers, where the apparition of alcohol withdrawal symptoms might be frequent. Patients and methods: We have performed a retrospective analysis of the hospital in Galicia Hospitals with the diagnosis of Alcohol Withdrawal (AW) or Delirium Tremens (DT) from 1 January 1996 to 31 December 2008. Data were provided by the computerized administrative database of the hospitals of Sergas and Povisa. Data were collected regarding age, gender, mean stay, admission department, length of stay and clinical course. Results: We identified 7990 cases in 6452 patients, 78% AW and 22% DT, with mean stay of 13,7 days (SD: 14,8). Mean age was 52 years old (SD: 13), 85% male. AW or DT were the main diagnosis in 45% of discharges, and in 73% of cases it was into the three main diagnoses. 55% of patients were admitted to Internal Medicine departments and 24% to Critical Care Units. Mortality was 4,6%. AWS was present in 0,27% of all admissions to medical and surgical Hospital-Services. Considering Internal trfrff qASWA<DSXZSAZ< 2A departments, AWS was present in 0,95% of all discharges. During the period 2007-2008, cases of AW have decreased both in Internal Medicine (0,76%) and other Hospital-Services (0,24%). Conclusions: The prevalence of AWS in our community is relatively high and its mortality is significant. Internal Medicine services are most frequently involved in its management.Definimos Síndrome de Abstinencia Alcohólica (SAA) a la aparición de sintomatología relacionada con la disminución o interrupción de consumo de alcohol, que incluyen síntomas como cefalea, sudoración, temblor, insomnio, nerviosismo, náuseas, vómitos, alucinaciones auditivas y visuales, o convulsiones; evolucionando algunos a Delirium Tremens. Objetivo: Conocer la prevalencia y características epidemiológicas del SAA en Galicia; Comunidad Autónoma española con alta prevalencia de consumidores de riesgo de bebidas alcohólicas en la que la aparición de sintomatología relacionada con abstinencia alcohólica debe, por lo tanto, ser frecuente. Material y métodos: Se estudiaron las características epidemiológicas de los pacientes ingresados en los centros hospitalarios de Galicia entre cuyos diagnósticos se incluía Abstinencia de Alcohol (AA) o Delirio por Abstinencia de Alcohol (DAA) desde 1 de Enero de 1996 al 31 de Diciembre de 2008. Los datos fueron facilitados de la base de datos del CMBD (Conjunto Mínimo Básico de Datos) de altas hospitalarias de los hospitales de agudos del Sergas y de Povisa. Recogimos los datos referentes a edad, sexo, estancia media, servicio de ingreso, estancias en diferentes servicios y la evolución. Resultados: Se identificaron 7990 casos en (6452 pacientes), un 78% AA y un 22% DAA con una estancia media 13,7 días (DE: 14,8). La edad media fue de 52 años (DE 13), 85% varones. La AA o DAA fueron el diagnóstico principal de ingreso hospitalario en el 45% de los casos, y estuvieron presentes en el 73% de las altas cuando consideramos los 3 primeros diagnósticos. El 55% de los pacientes ingresaron inicialmente en el servicio de Medicina Interna (55%), y un 24% precisaron ingreso en la Unidad de Cuidados Intensivos. La mortalidad fue del 4,6%. El SAA supuso el 0,27% de los ingresos en estos años en el global de los Servicios Hospitalarios, tanto médicos como quirúrgicos. Considerando el servicio de Medicina Interna, dicho porcentaje se elevó al 0,95%. En los años 2007-2008 descendió el número de casos tanto en Medicina Interna (0,76%) como en el resto de los Servicios Hospitalarios (0,24%). Conclusiones: El SAA tiene una prevalencia relativamente elevada en nuestra comunidad y una mortalidad destacable. Los servicios de Medicina Interna son los más frecuentemente implicados en su atención

Treatment variability and its relationships to outcomes among patients with Wernicke's encephalopathy : A multicenter retrospective study

CatedresBackground: Despite guidelines and recommendations, Wernicke's encephalopathy (WE) treatment lacks evidence, leading to clinical practice variability. Aims: Given the overall lack of information on thiamine use for WE treatment, we analyzed data from a large, well-characterized multicenter sample of patients with WE, examining thiamine dosages; factors associated with the use of different doses, frequencies, and routes; and the influence of differences in thiamine treatment on the outcome. Methods: This retrospective study was conducted with data from 443 patients from 21 centers obtained from a nationwide registry of the Spanish Society of Internal Medicine (from 2000 to 2012). Discharge codes and Caine criteria were applied for WE diagnosis, and treatment-related (thiamine dosage, frequency, and route of administration) demographic, clinical, and outcome variables were analyzed. Results: We found marked variability in WE treatment and a low rate of high-dose intravenous thiamine administration. Seventy-eight patients out of 373 (20.9%) received > 300 mg/day of thiamine as initial dose. Patients fulfilling the Caine criteria or presenting with the classic WE triad more frequently received parenteral treatment. Delayed diagnosis (after 24 h hospitalization), the fulfillment of more than two Caine criteria at diagnosis, mental status alterations, and folic acid deficiency were associated significantly with the lack of complete recovery. Malnutrition, reduced consciousness, folic acid deficiency, and the lack of timely thiamine treatment were risk factors for mortality. Conclusions: Our results clearly show extreme variability in thiamine dosages and routes used in the management of WE. Measures should be implemented to ensure adherence to current guidelines and to correct potential nutritional deficits in patients with alcohol use disorders or other risk factors for WE

Alcoholic Liver Disease Among Patients with Wernicke Encephalopathy: A Multicenter Observational Study

Background: data regarding the association between Wernicke encephalopathy (WE) and alcoholic liver disease (ALD) are scarce in spite of alcohol consumption being the main risk factor for WE. Aims: to describe the frequency of ALD in a cohort of patients diagnosed with WE and alcohol use disorders (AUDs) and to compare the characteristics of WE patients with and without ALD. Methods: we conducted an observational study in 21 centers through a nationwide registry of the Spanish Society of Internal Medicine. WE Caine criteria were applied and demographic, clinical, and outcome variables were analyzed. Results: 434 patients were included in the study, of which 372 were men (85.7%), and the mean age was 55 ± 11.8 years. ALD was present in 162 (37.3%) patients and we found a higher percentage of cases with tremor, flapping and hallucinations in the ALD group. A total of 22 patients (5.0%) died during admission (7.4% with ALD vs 3.7% without ALD; P = 0.087). Among the ALD patients, a relationship between mortality and the presence of anemia (Odds ratio [OR]=4.6 Confidence interval [CI]95% 1.1-18.8; P = 0.034), low level of consciousness (OR=4.9 CI95% 1.1-21.2; P = 0.031) and previous diagnosis of cancer (OR=10.3 CI95% 1.8-59.5; P = 0.009) was detected. Complete recovery was achieved by 27 patients with ALD (17.8%) and 71 (27.8%) without ALD (P = 0.030). Conclusion: the association of WE and ALD in patients with AUDs is frequent and potentially linked to differences in clinical presentation and to poorer prognosis, as compared to alcoholic patients with WE without ALD