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

Tendencias sobre los parámetros del grado de control de los pacientes con diabetes tipo 2 desde el año 2010 al año 2015

Resumen: Introducción: Objetivo: examinar la tendencia del grado de control de hemoglobina glucada (HbA1c), tensión arterial (TA) y colesterol LDL (c-LDL) en el paciente con diabetes mellitus tipo 2 entre los años 2010 y 2015. Métodos: Ámbito: 3 cortes en los años 2010, 2013 y 2015. Zona sureste del municipio y la comunidad de Madrid. Diseño: Estudio epidemiológico descriptivo y transversal. Participantes: Pacientes con diabetes mellitus tipo 2 diagnosticada y registrada; n = 41.096 (2010), n = 49.658 (2013), n = 6.674 (2015). Mediciones principales: Medición o no en el último año de HbA1c, TA y c-LDL. Control o no de HbA1c (< 7% individualizando objetivo), TA (< 140/90 mmHg) y c-LDL (< 100 mg/dl; si enfermedad cardiovascular < 70 mg/dl). Los datos se recogieron de registros de la historia clínica electrónica.Se utilizó el test de Chi-cuadrado. Resultados: El porcentaje de pacientes con medición de cada parámetro en 2010, 2013 y 2015 fue el siguiente. HbA1c: 36,4; 37; 62% (p < 0,001); TA: 33,2; 43,3; 65% (p < 0,001); c-LDL: 32,9; 33,2; 43,5% (p < 0,001).El porcentaje de pacientes con cada parámetro medido y controlado en 2010, 2013 y 2015 fue el siguiente. HbA1c: 59,6; 59,1; 79,6% (p < 0,001); TA: 74,9; 67,4; 79,2% (p < 0,001); c-LDL: 41,8; 58,3; 58,8% (p < 0,001). Conclusión: En el período 2010-2015 se observó una tendencia mantenida, pero insuficiente de mejor control de HbA1c, TA y c-LDL en pacientes con diabetes. Mejoró más la frecuencia de las mediciones de estos parámetros que el control de las cifras. Parece que los esfuerzos dedicados a la mejora de la atención al paciente con diabetes dan sus frutos, pero aún deben mantenerse. Abstract: Introduction: Aim: To examine the trend in the level of control of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL) in patients with type 2 diabetes mellitus between 2010 and 2015. Methods: Setting: 3 cut-offs in the years 2010, 2013, and 2015. Southeast area of Madrid. Design: Descriptive and cross-sectional epidemiological study. Participants: Patients diagnosed and registered with type 2 diabetes. N = 41,096 (2010), n = 49,658 (2013), n = 6,674 (2015) Main measurements: Measurement or not in the last year of HbA1c, BP, and LDL. Control of HbA1c (< 7% individual targeting), BP (< 140/90 mmHg), and LDL (< 100 mg/dL, if cardiovascular disease < 70 mg/dL). Data were collected from electronic records of clinical history.The Chi-square test was used. Results: The percentages of patients with each parameter measured in 2010, 2013 and 2015 were: HbA1c: 36.4%, 37.0%, 62.0% (P < .001); BP: 33.2%, 43.3%, 65.0% (P < .001); LDL: 32.9%, 33.2%, 43.5% (P < .001).The percentages of patients with each parameter measured and controlled in 2010, 2013, and 2015 were: HbA1c: 59.6%, 59.1%, 79.6% (P < .001); BP: 74.9%, 67.4%, 79.2% (P < .001); LDL: 41.8%, 58.3%, 58.8% (P < .001) Conclusion: In the 2010-2015 period, a sustained but insufficient trend of better control of HbA1c, BP and LDL was observed in patients with diabetes. The frequency of the measurements of these parameters improved more than the control of them. It seems that efforts to improve care for the patient with diabetes pay off, but they still have to be maintained. Palabras clave: Diabetes, Riesgo cardiovascular, Atención primaria, Enfermedad cardiovascular, Keywords: Diabetes, Cardiovascular risk, Primary care, Cardiovascular diseas

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

CatedresBackground: 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

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