Independent Clinical Correlates of Severe Alcohol Withdrawal

This retrospective cohort study sought to identify clinical variables that independently correlate with severe alcohol withdrawal and to quantify risk in a clinically useful manner. The records of 284 inpatients admitted to an acute detoxification unit at a Veterans Affairs teaching hospital were reviewed. Clinical data were recorded on standardized forms at the time of admission and abstracted by a physician reviewer. Alcohol withdrawal severity was prospectively measured with the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Seventy-one patients (25% of cohort) had severe withdrawal. We identified six independent correlates of severe withdrawal: use of a morning eye-opener (adjusted odds ratio [OR], 5.6; 95% confidence interval [CI], 1.2–25.9), an initial CIWA-Ar score q 10 (OR, 5.1; 95% CI, 2.4–10.6), a serum aspartate aminotransferase 80 U/L (OR, 4.2; 95% CI, 2.0–8.8), past benzodiazepine use (OR, 3.6; 95% CI, 1.3–9.9), self-reported history of delirium tremens (OR, 2.9; 95% CI, 1.3–6.2), and prior participation in two or more alcohol treatment programs (OR, 2.6; 95% CI, 1.3–5.6). Significantly higher risk was observed in subjects with three or more independent correlates. In conclusion, several readily available clinical variables correlate with the occurrence of severe alcohol withdrawal. Ascertainment of these variables early in the course of alcohol withdrawal has the potential to improve triage and treatment decisions.     

Risk for delirium tremens in patients with alcohol withdrawal syndrome 1

To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case‐control study at the detoxification units of two hospitals. Cases met DSM‐IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens.     

Secular Trends in Prevalence of Alcohol Use Disorder and Its Correlates in Korean Adults: Results from Korea National Health and Nutrition Examination Survey 2005 and 2009

ABSTRACT

The Alcohol Use Disorders Identification Test (AUDIT) has been found to provide an accurate measure for risk of hazardous and harmful alcohol use, as well as possible dependence. Data from 2 representative samples of 7693 adults in the Korea National Health and Nutrition Examination Survey (KNHANES) 2005 and 6276 participants in 2009 were analyzed. The overall age-adjusted prevalence of alcohol use disorder (AUD) in 2009 (38.8%) was higher than that in 2005 (32.7%), with a difference of 6.1% (95% confidence interval [CI], 2.9%–9.3%; P = .0002). Men were about 7 times as likely as women to meet the criteria for AUD (odds ratio [OR] = 7.16; 95% CI, 6.27–8.17). Current smoking was the most important correlate associated with AUD in both genders (women: OR = 6.03; 95% CI, 4.40–8.27; men: OR = 2.83; 95% CI, 2.29–3.48). Among women, unmarried (OR = 1.76; 95% CI, 1.35–2.31), less than high school education (OR = 2.71, 95% CI, 1.86–3.96), and lowest income (OR = 1.45, 95% CI, 1.06–1.97) were associated with AUD. These findings provide the most updated prevalence estimates of AUD in the Korean population and they highlight its strong association with smoking, gender differences, and lower socioeconomic status in the Korean population.     

Risk for Delirium Tremens in Patients with Alcohol Withdrawal Syndrome

To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case-control study at the detoxification units of two hospitals. Cases met DSM-IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI 4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens.     

Prevalence of Alcoholic Liver Disease Among Korean Adults: Results From the Fourth Korea National Health and Nutrition Examination Survey, 2009

Background/Aim: Alcohol consumption continues to be a common cause of acute and chronic liver disease. Methods: Data from a representative sample of 7,893 adults in the Korean National Health and Nutrition Examination Survey 2009 were analyzed. Alcoholic liver disease (ALD) was defined through heavy alcohol consumption (≥40 g/day for men or ≥20 g/day for women) and through elevated liver tests. Results: Approximately 6.7% (95% confidence interval [CI], 6.0–7.4) was at heavy alcohol consumption. Of these “heavy alcohol consumers,” one quarter also had ALD. The prevalence of ALD was 1.7% (95% CI, 1.3–2.1). Conclusion: ALD is still a burden in the Korean population.     

Routes of cannabis administration among adolescents during criminal prohibition of cannabis in Canada

Abstract

This report assesses sociodemographic correlates of cannabis routes of administration (ROAs) among adolescents in 2017, one year prior to legalization of cannabis in Canada. We analyze a subsample of 809 students (Grades 9–12) from the Ontario Student Drug Use and Health Survey (OSDUHS) who used cannabis in the previous year. Pipes/bongs/waterpipes (81.8%) are the most prevalent ROA, followed by joints (73.8%) and edibles (42%). Approximately 70% of students report 2+ ROAs. Alcohol use in the previous year is associated with 2.28 (1.3–5.58 OR; 95% CI) times the odds of food/drink ROA and 2.91 (1.10–3.89; 95% CI) times the odds of joint ROA. Tobacco use is associated with 1.60 (1.07–2.41 OR; 95% CI) times the odds of blunt ROA, 2.07 (1.10–3.89; 95% CI) times the odds of pipe/bong/waterpipe ROA, and 1.75 (1.03–2.95 OR; 95% CI) times the odds of e-cigarette/vape pen/vaporizer ROA. Students who used alcohol have a rate 1.59 (1.08–2.36 IRR; 95% CI) times greater for total ROA count, and students who used tobacco have a rate 1.24 (1.09–1.40 IRR; 95% CI) times greater. Given young people’s vulnerability to adverse outcomes associated with cannabis use, it is important to track ROA trends to inform harm reduction and educational programing and to evaluate impacts of policy changes.     

Drug‐using mothers: Factors associated with retaining care of their children

Introduction and Aims. Research suggests that upwards of 50% of drug users do not live with their children, yet little is known about these children's living arrangements or the variables associated with mothers retaining care of their children. Design and Methods. This cross‐sectional study examined the number of pregnancies and children born to female drug users receiving and not receiving treatment, the living arrangements of their children and the variables associated with not living with their children. Results. Data on 185 mothers from a study on psychiatric morbidity among drug users in Glasgow, Scotland were analysed. Participants had given birth to 327 children, 44% (132/297) of children were living with their mother; 26% (78/297) were being cared for by a family member and 20% (59/297) were in local authority care or had been adopted. 49% (87/179) of participants did not live with any of their children. Stepwise multiple forward logistic regression found that current depressive symptoms [odds ratios (OR) 3.90, 95% confidence intervals (CI) 1.78–8.55], lifetime involvement in prostitution (OR 3.12, 95% CI 1.41–6.93), lifetime history of homeless (OR 2.96, 95% CI 1.13–6.39), living with a drug user (OR 2.71, 95% CI 1.30–5.65) and ever being incarcerated (OR 2.47, 95% CI 1.17–5.21) were associated with participants not living with any of their children versus living with at least one of their children. Discussion and Conclusions. Access to drug treatment, mental health treatment and parent craft education should be enhanced for female drug users to assist them retain care of their children where possible.[Gilchrist G, Taylor A. Drug‐using mothers: Factors associated with retaining care of their children. Drug Alcohol Rev 2009]     

The Cedar Project: methadone maintenance treatment among young Aboriginal people who use opioids in two Canadian cities

Introduction and Aims. The Cedar Project is a community‐based study aiming to identify variables associated with ever being on methadone maintenance treatment (MMT) among young Aboriginal people using drugs and to discuss possible barriers to MMT in this population. Design and Methods. This is a prospective cohort study with recruitment by health‐care providers, outreach, and word of mouth in Vancouver and Prince George. Participants included 605 Aboriginal participants who were age 14–30 years, reported illicit drug use in the month prior to enrolment, and provided written informed consent. Variables associated with ever being on MMT were analysed through χ²‐testing and multivariate logistic regression, limited to people reporting opioid use (n = 397). Results. Less than half of participants reporting daily injection of opioids had ever been on MMT. In adjusted multivariate logistic regression analyses, older age [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.08–1.28)]; female gender (OR 3.76; 95% CI 2.00–7.07); hepatitis C antibody positivity (OR 2.76; 95% CI 1.53–4.95); and daily opioid injection (OR 2.59; 95% CI 1.46–4.61) were positively associated with ever being on MMT. Weekly or more alcohol use (OR 0.43; 95% CI 0.21–0.87) was negatively associated with ever being on MMT. Discussion and Conclusion. MMT access by young Aboriginal people is low. The associations between MMT use and other variables need further study to steer efforts directed at recruitment into MMT. The removal of barriers to MMT and inclusion of young Aboriginal people in the development of treatment programs based on Indigenous values are urgently required to help Aboriginal people who use drugs.[Yang J, Oviedo‐Joekes E, Christian KWM, Li K, Louie M, Schechter M, Spittal P. The Cedar Project: Methadone maintenance treatment among young Aboriginal people who use opioids in two Canadian cities. Drug Alcohol Rev 2011;30:645–651]     

Pelvic floor disorders and quality of life in women with self‐reported irritable bowel syndrome

Aliment Pharmacol Ther 31 , 424–431

Summary

Background Quality of life among women with irritable bowel syndrome may be affected by pelvic floor disorders. Aim To assess the association of self‐reported irritable bowel syndrome with urinary incontinence, pelvic organ prolapse, sexual function and quality of life. Methods We analysed data from the Reproductive Risks for Incontinence Study at Kaiser Permanente, a random population‐based study of 2109 racially diverse women (mean age = 56). Multivariate analyses assessed the association of irritable bowel syndrome with pelvic floor disorders and quality of life. Results The prevalence of irritable bowel syndrome was 9.7% (n = 204). Women with irritable bowel had higher adjusted odds of reporting symptomatic pelvic organ prolapse (OR 2.4; 95% CI, 1.4–4.1) and urinary urgency (OR 1.4; 95% CI, 1.0–1.9); greater bother from pelvic organ prolapse (OR 4.3; 95% CI, 1.5–11.9) and faecal incontinence (OR 2.0; 95% CI, 1.3–3.2); greater lifestyle impact from urinary incontinence (OR 2.2; 95% CI, 1.3–3.8); and worse quality of life (P < 0.01). Women with irritable bowel reported more inability to relax and enjoy sexual activity (OR 1.8; 95% CI, 1.3–2.6) and lower ratings for sexual satisfaction (OR 1.8; 95% CI, 1.3–2.5), but no difference in sexual frequency, interest or ability to have an orgasm. Conclusions Women with irritable bowel are more likely to report symptomatic pelvic organ prolapse and sexual dysfunction, and report lower quality of life.     

The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population

A survey was carried out using the Canterbury Alcohol Screening Test (CAST) and clinical criteria for risk of alcohol withdrawal of 2000 randomly selected hospital in-patients in order to determine the prevalence of alcohol-related problems, the work-load for a specialist alcohol withdrawal service and the target group for early intervention. Patients at risk of alcohol withdrawal were followed prospectively.

The major findings were: 14.3% of patients had a positive CAST and 8% were at risk of alcohol withdrawal; the prevalence of positive clinical criteria was greatest in men under the age of 30 years (OR 3.6) and very low (OR 0.34) in women over 60 years. In addition, patients who were too sick or refused to complete the questionnaire had high rates of being at risk for alcohol withdrawal. The prevalence of CAST positivity was greatest in men under the age of 40 years (OR 3.7) and lowest in women over 70 years (OR 0.2).

It is concluded that 15-20% of in-patients have alcohol problems and 8% are at risk of withdrawal; questionnaires will produce underestimates of the order of 25%; and female in-patients over the age of 60 years are extremely unlikely to have problems with alcohol.     

Development and implementation of an alcohol withdrawal protocol using a 5-item scale,the Brief Alcohol Withdrawal Scale (BAWS)

Background: The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. Methods: A 6-item withdrawal scale developed at another institution was piloted. Based on comparison with the CIWA-Ar, this was adapted into a 5-item scale named the Brief Alcohol Withdrawal Scale (BAWS). The BAWS was compared with the CIWA-Ar and a withdrawal protocol utilizing the BAWS was developed. The new protocol was implemented on an inpatient unit dedicated to treating substance withdrawal. Data was collected on the first 3 months of implementation and compared with the 3 months prior to that. Results: A BAWS score of 3 or more predicted CIWA-Ar score ≥8 with a sensitivity of 85.3% and specificity of 65.8%. The demographics of the patients in the 2 time periods were similar: the mean age was 45.9; 70.6% were male; 30.9% received concurrent treatment for opioid withdrawal; and 14.2% were receiving methadone maintenance. During the BAWS phase, patients received significantly less diazepam (mean dose 81.4 vs. 60.3 mg, P < .001). There was no significant difference in length of stay. No patients experienced a seizure, delirium, or required transfer to a higher level of care during any of the 664 admissions in either phase. Conclusions: This simple protocol utilizing a 5-item withdrawal scale performed well in this setting. Its use in other settings, particularly with patients with concurrent medical illnesses or more severe withdrawal, needs to be explored further.     

The impact of infliximab infusion reactions on long-term outcomes in patients with Crohn's disease

Background Little is known about long‐term outcomes in patients who experience infusion reactions while receiving infliximab. Aim To investigate long‐term outcomes in patients who experience infusion reactions while receiving infliximab. Methods Retrospective electronic chart review of long‐term clinical outcomes. Results Clinical data on 287 patients who received infliximab infusions for Crohn’s disease were reviewed, of whom 51 developed at least one infusion reaction (18%). Ileo‐colonic disease (OR 2.2, 95% CI 1.1–4.4) and episodic infliximab (OR 2.4, 95% CI 1.2–4.7) were associated with a higher risk of infusion reactions in univariate analysis, but concomitant azathioprine/mercaptopurine therapy at the initiation of infliximab was associated with a reduced risk (OR 0.4, 95% CI 0.2–0.8). Only the effect of concomitant immunomodulators persisted on multivariate analysis. Patients who experienced infusion reactions were less likely to be in remission at 1 year (OR 0.6, 95% CI 0.3–1.2), 2 years (OR 0.4, 95% CI 0.2–0.8, P = 0.01), or 5 years (OR 0.4, 95% CI 0.1–1.3) and more likely to require surgery (OR 2.2, 95% CI 1.1–4.1, P = 0.01) than those who did not experience such reactions. Conclusions Patients who experienced infusion reactions to infliximab had a high rate of discontinuation of therapy in this cohort. Concomitant immunomodulators and maintenance therapy reduced the risk of infusion reactions.     

Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study

BackgroundThe risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aimed to evaluate changes in risk behaviours during and following HCV treatment among people with ongoing injecting drug use or receiving opioid substitution treatment (OST).MethodsACTIVATE was an international multicentre clinical trial conducted between 2012 and 2014. Participants with HCV genotypes 2/3 infection were treated with peg-interferon/ribavirin for 12 or 24 weeks and completed a self-administered behavioural questionnaire at each study visit. The impact of time in treatment and follow-up on longitudinally measured recent (past month) behavioural outcomes was evaluated using generalized estimating equations.ResultsAmong 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected in the past month. Any injecting drug use decreased during HCV treatment and follow-up (OR 0.89 per incremental study visit; 95% CI 0.83–0.95). No significant changes were found in ≥daily injecting (OR 0.98; 95% CI 0.89–1.07), use of non-sterile needles (OR 0.94; 95% CI 0.79–1.12), sharing of injecting paraphernalia (OR 0.87; 95% CI 0.70–1.07) or non-injecting drug use (OR 1.01; 95% CI 0.92–1.10). Hazardous alcohol use decreased throughout (OR 0.56; 95% CI 0.40–0.77) and OST increased between enrolment and end of treatment (OR 1.48; 95% CI 1.07–2.04).ConclusionsRecent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.     

Attitudes and Behaviors with Regards to Androgenic Anabolic Steroids Among Male Adolescents in a County of Sweden

This study investigates attitudes toward androgenic anabolic steroids among male adolescents who have used anabolics compared with those who have not. A cross-sectional survey was performed in the year 2000 in all secondary schools in the county of Halland on the west coast of Sweden. An anonymous multiple-choice questionnaire was distributed to all classes with 14-, 16-, and 18-year-old male adolescents. The response rate was 92.7% (n = 4049). Those who admitted having used androgenic anabolic steroids differed in several ways from those who had not. Fewer believed androgenic anabolic steroids to be harmful (OR = 0.15, 95% CI 0.08–0.30) and more believed that girls preferred boys with large muscles (OR = 6.1, 95% CI 3.4–11.0). They trained more often at gyms (OR = 5.6, 95% CI 3.0–10.6), drank more alcohol (OR = 4.2, 95% CI 2.0–9.1), and had used narcotic drugs more often (OR = 15.3, 95% CI 8.5–27.5) than the other male adolescents. More immigrants than native-born adolescents had used anabolics (OR = 4.2, 95% CI 2.2–7.9). Attitudes toward anabolics differ between users and nonusers. These aspects may be beneficial to focus on as one part of a more complex intervention program in order to change these attitudes and decrease the misuse of androgenic anabolic steroids.     

Relationship between specific serum IgE to Ascaris lumbricoides and onset of respiratory symptoms in Bangladesh immigrants

The role of helminths in asthma and/or rhinitis and in allergic sensitization is still unclear. We assessed the relationship between Ascaris-specific IgE, respiratory symptoms and allergic sensitization in Bangladesh immigrants. 246 individuals were examined from 1996 to 2001. Serum total IgE, Ascaris IgE, specific IgE to inhalant allergens, skin prick tests (SPT) and parasitological evaluation of the stool were performed. Total serum IgE were significantly higher in Ascaris-IgE positive (> 0.35 kU/L) individuals (806.5 [409.0-1436.0] kU/L vs. 207.0 [127.0-332.5] kU/L; P < 0.0001) and in subjects with respiratory symptoms (413.0 [239.0-1096.0] kU/L vs. 259.5 [147.0-387.0] kU/L), (P < 0.0001), but not in SPT positive subjects (413.0 [179.0-894.0] kU/L vs. 404.6 [305.0-1201.0] kU/L (P = 0.5). Ascaris-specific IgE were detected in 48 subjects with respiratory symptoms (40.0%) and in 46 subjects without respiratory symptoms (36.5%) (P = 0.5). The SPT positivity was similar between Ascaris-IgE seropositive (38.2%) and Ascaris-IgE seronegative (38.1%) subjects (P = 0.9). Total IgE and length of stay in Italy correlated with SPT positivity (OR 5.6 [CI 95% 1.5-19.8], P = 0.007, and OR 1.5 [CI 95% 1.3-1.7], P< 0.0001), and with respiratory symptoms (OR 13.7 [CI 95% 3.0-62.4];, P = 0.0007, and OR 2.4 [CI 95% 1.9-3.0], P < 0.0001). Ascaris-IgE were negatively associated with SPT positivity (OR 0.3 [CI 95% 0.1-0.8], P = 0.02) and with respiratory symptoms (OR 0.1 [CI 95% 0.04-0.7], P = 0.01). Our findings favour the role of environmental factors in the development of respiratory symptoms in immigrants, irrespective of Ascaris-IgE.     

Family Factors and Adolescent Problem Drinking in a High-Risk Urban Peruvian Neighborhood

Background: Family relationships are widely recognized as playing a role in adolescent alcohol use. Although family relationships and parenting vary by culture, limited research has explored these relationships in Latin America. Objectives: We sought to determine which family factors are associated with adolescent alcohol use in Callao, Peru. Methods: Data come from a cross-sectional survey conducted in a public secondary school in Callao, Peru in 2007. A total of 180 11th grade students are included in the analysis. Our main outcome measure was problem drinking, defined as self-report of having ever consumed beer, wine, spirits, or hard alcohol to a point of drunkenness. Logistic regression was used to determine if odds of problem drinking varied by level of parental monitoring (knowledge of activities and whereabouts), positive family relationships, or family conflict, while controlling for demographic and peer variables. Results: Low levels of parental monitoring and low levels of positive family relationships were each associated with significantly higher odds of lifetime problem drinking in analyses adjusted for deviant peer affiliation along with sociodemographic variables (odds ratio (OR) = 4.2; 95% confidence interval (CI): 1.3–13.5; OR = 4.4; 95% CI: 1.5–13.0, respectively). Although family conflict was associated with elevated odds of lifetime problem drinking, this did not reach significance (adjusted OR = 2.01; 95% CI: 0.8–5.1). Conclusions/Importance: Interventions designed to prevent adolescent alcohol use in urban Peru may benefit from promoting positive family interactions and parental monitoring skills.     

Substance Use Prevalence and Screening Instrument Comparisons in Urban Primary Care

ABSTRACT

Substance use screening in a primary care setting compared the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST version 3.0), Two-Item Conjoint Screen (TICS), National Institute on Alcohol Abuse and Alcoholism (NIAAA) daily limit single item, and electronic medical record (EMR). Among 236 consecutive adults, ASSIST moderate- to high-risk substance use prevalence was tobacco, 15.3%; alcohol, 8.5%; cannabis, 5.1%; cocaine, 2.5%; and opioids, 2.5%. Compared to ASSIST, a positive TICS was 45% (95% confidence interval [CI], 27–64%) sensitive, 99% (95–100%) specific; the NIAAA single-item screen was 80% (56–94%) sensitive, 87% (82–91%) specific. The NIAAA single item correlated closely with alcohol ASSIST. TICS and EMR were less sensitive for any nontobacco substance use.     

Reports of withdrawal syndrome with the use of SSRIs: a case/non-case study in the French Pharmacovigilance database

The SSRIs can be associated with withdrawal reactions and the objective of this study is to test the existence of an association between reports of withdrawal syndromes with the selective serotonin re-uptake inhibitors in the French spontaneous reports database. All reactions are coded according to the WHO ART dictionary. Cases are reports of reactions of interest (withdrawal syndrome). Non-cases are all reports of reactions other than those being studied. We calculated the odds ratio (OR) as the ratio of the odds of the association of reports of withdrawal syndrome with SSRIs in cases and non-cases. SSRIs are clearly associated with a higher risk of withdrawal syndrome (OR: 5.05, 95% CI: 3.81-6.68) and in particular with venlafaxine and paroxetine (OR: 12.16, 95% CI: 6.17-23.35 and OR: 8.47, 95% CI: 5.63-12.65, respectively). The risk of withdrawal reactions appears to be greater with short half-life drugs such as paroxetine and venlafaxine. The precise mechanisms have not been identified.     

Alcohol screening scores and the risk of intensive care unit admission and hospital readmission

ABSTRACT

Background: The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. Methods: This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. Results: Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%–2.3%) for abstinent patients, 1.6% (95% CI: 1.3%–1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%–2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%–2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%–49%) in abstinent patients, 44% (42%–45%) in patients with lower-risk alcohol use, 42% (39%–45%) in patients with moderate alcohol misuse, and 55% (49%–60%) in patients with severe alcohol misuse. Conclusions: Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.