Alcohol withdrawal during hospitalizations

Concerns with unhealthy alcohol use

Alcohol use disorder (AUD) is a serious concern associated with multiple health risks including organ failure, severe infection, suicide and death. Alcohol withdrawal syndrome (AWS) is indicative of physical dependence on alcohol, a diagnostic criterion for AUD.

There are various symptoms of AWS on the spectrum of severity, from anxiety, shakiness, vomiting and mild fever to potentially fatal symptoms like seizures, high heart rate, disorientation and hallucinations. Individuals may require hospitalization for AWS or experience AWS as a complication of hospitalization for other conditions.

As AUD is a common and preventable chronic disease, understanding the rates at which AWS results in hospitalization is an important part of understanding the impacts of current prevention and treatment strategies.

Study design

To better understand the scope of this issue, UW investigators conducted a study to determine the incidence of AWS hospitalizations in a diverse adult primary care population served by a large health care system.

They also compared hospitalizations involving AWS with the incidence of hospitalizations involving other common chronic conditions conventionally used to monitor the quality of primary care: COPD, diabetes, heart failure, and hypertension.

The study was recently published in JAMA Network Open, by lead author Dr. Tessa Steel, assistant professor (Pulmonary, Critical Care, & Sleep Medicine), co-authors Drs. Helen Jack and Doug Berger (General Internal Medicine), and investigators from the UW Department of Psychiatry and Behavioral Sciences and Kaiser Permanente Washington Health Research Institute.  

The study looked at hospitalization rates among an adult population insured by Kaiser Permanente Washington (KPWA), who visited a KPWA primary care clinic at least once during the study between July 1, 2018, and June 30, 2022 or one year prior.

Before the study period, KPWA began using standardized protocols for annual alcohol screening in primary care using the 3-question Alcohol Use Disorders Identification Test–Consumption (AUDIT-C). In addition to obtaining incidence of hospitalizations involving AWS and other chronic conditions, investigators also factored in AUDIT-C (i.e., alcohol use screening) scores to evaluate correlation.

Results

“The study describes the impressive incidence of alcohol withdrawal during hospitalizations, which is especially common in men and younger adults,” said Steel.

Approximately 2% of adult hospitalizations within the cohort involved AWS, with substantial variation by age, sex, race, and outpatient alcohol screening scores.

For men and younger adults, incidence was higher: AWS accounted for 9-11% of hospitalizations in men ages 30-49 years. 

“In patients younger than 60 years, alcohol withdrawal was as common or more common than complications of other chronic conditions (e.g., diabetes, hypertension) that receive greater medical attention,” she said. 

Individuals with high-risk and very high-risk AUDIT-C scores also had elevated incidence of hospitalizations involving AWS.

Significantly, the study population was diverse in terms of age, sex, race and ethnicity, providing more information for various groups compared to previous studies of inpatient AWS.

Implications

This study highlights important issues for providers and policymakers seeking to address AUD.

“Less than a quarter of patients with AUD receive evidenced-based treatments for their disease.”

Similar to hospitalizations for other chronic conditions, hospitalizations involving AWS indicate a need for more targeted interventions and earlier disease management strategies. 

The study reinforces the need for health care systems to prioritize identification, monitoring and treatment of AUD to reduce risk of complications and improve patients’ health.