Estudio retrospectivo de cohorte sobre el antecedente de síndrome de abstinencia al alcohol y su asociación con delírium trémens en hospitalizaciones posteriores, Medellín, 2010-2012

RESUMEN Introduccion: el consumo excesivo de alcohol es un problema de salud publica a nivel mundial que ocasiona anualmente, segun la Organizacion Mundial de la Salud, 2,5 millones de muertes. En Colombia, el 11% de los mayores de 15 anos cumple los criterios de abuso de alcohol del DSM-IV, con las consecuencias personales, legales y sociales que este implica, incluyendo las complicaciones asociadas al consumo cronico como el sindrome de abstinencia al alcohol y el delirium tremens . Objetivo: determinar si el antecedente de sindrome de abstinencia al alcohol se asocia con una mayor aparicion de delirium tremens en pacientes atendidos por este sindrome en la ciudad de Medellin entre agosto de 2010 y julio de 2012. Materiales y metodos: se realizo un estudio de cohorte retrospectivo, comparando pacientes con y sin antecedente de sindrome de abstinencia al alcohol y el desarrollo de delirium tremens, ademas de otras posibles asociaciones como disfuncion hepatica y desequilibrios electroliticos. El analisis de los datos fue de tipo bivariado, por medio de las pruebas estadisticas c2, Fisher y Mann Whitney. Resultados: se incluyeron 60 pacientes, en las caracteristicas de base el 67% presentaron sindrome de abstinencia a alcohol, y 22% tuvieron antecedente de delirium tremens. Durante la estancia hospitalaria 56% de los sujetos desarrollaron delirium tremens. El antecedente de sindrome de abstinencia al alcohol no se asocio con desarrollar delirium tremens (p=0,26). En tanto que el antecedente de delirium tremens se comporto como un factor de riesgo para presentarlo nuevamente (p=0,02). Conclusion: el antecedente de sindrome de abstinencia al alcohol no se encontro relacionado con el desarrollo de delirium tremens en hospitalizaciones posteriores, en tanto que el antecedente de delirium tremens esta asociado con la aparicion de nuevos episodios. (MED. UIS. 2014;27(1):17-23). Palabras clave: Delirium Tremens. Sindrome de Abstinencia a Sustancias. Factores de Riesgo. History of alcohol withdrawal syndrome and its association with delirium tremens on later hospitalizations: retrospective cohort study ABSTRACT Introduction: alcohol abuse is a public health problem around the world, which causes 2.5 million deaths per year according to the World Health Organization. In Colombia, 11% of the male population older than 15 years fulfills the DSM-IV criteria for alcohol abuse, with the personal, legal and social consequences that it entails, including those associated with chronic comsumption, such as withdrawal syndrome and delirium tremens. Objective: to establish if the history of alcohol withdrawal syndrome is related to a higher risk for development of delirium tremens in patients treated by this syndrome from the city of Medellin, between August of 2010 and July of 2012. Methods: this is a retrospective cohort study, with a comparison between patients with history of alcohol withdrawal syndrome and patients in their first episode, and the development of delirium tremens and the risk factors related with this. We did a bivariate analysis of the factors with the Mann Whitney, C2 and Fisher test. Results: 67% of the patients had a history of alcohol withdrawal syndrome and 22% showed previous episodes of delirium tremens. During hospitalization 56% of the subjects developed delirium tremens. The study showed that history of withdrawal syndrome is not a risk factor for the appearance of delirium tremens (p=0.26). In contrast, the record of delirium trermens is a risk for new episodes (p=0.02). Conclusion: the history of alcohol withdrawal syndrome appears not to be a risk factor for the development of delirium tremens in a new hospitalization. On the other hand, the history of delirium tremens was associated with new episodes of delirium. (MED.UIS. 2014;27(1):17-23). Keywords: Delirium Tremens. Substance Withdrawal Syndrome. Risk Factors. ?Como citar este articulo?: Arias-Correa RH, Uribe-Lopez D, Rodriguez CA, Zuluaga AF. Estudio retrospectivo de cohorte sobre el antecedente de sindrome de abstinencia al alcohol y su asociacion con delirium tremens en hospitalizaciones posteriores, Medellin, 2010-2012. MED.UIS.2014;27(1):17-23)

[1]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  Y. Skrobik,et al.  Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary , 2012, Intensive Care Medicine.

[3]  T. Schuster,et al.  Risk assessment of moderate to severe alcohol withdrawal--predictors for seizures and delirium tremens in the course of withdrawal. , 2011, Alcohol and alcoholism.

[4]  E. Rusch,et al.  [Risk factors for delirium tremens: a literature review]. , 2012, La Revue de medecine interne.

[5]  S. Pértega,et al.  Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. , 2010, Alcohol and alcoholism.

[6]  K. Blennow,et al.  Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. , 2009, Alcohol and alcoholism.

[7]  Ana María Valencia Ruiz,et al.  Alcohol and tobacco use by University Undergraduate students of Medellín, 2007 , 2009 .

[8]  T. Beresford What is addiction, what is alcoholism? , 2007, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[9]  H. Myrick,et al.  Risk factors for delirium tremens: a retrospective chart review. , 2006, The American journal on addictions.

[10]  K. Kim,et al.  Clinical predictors for delirium tremens in alcohol dependence , 2005, Journal of gastroenterology and hepatology.

[11]  E. Ruokonen,et al.  The proportion of intensive care unit admissions related to alcohol use: a prospective cohort study , 2005, Acta anaesthesiologica Scandinavica.

[12]  R. Horwitz,et al.  Risk for Delirium Tremens in Patients with Alcohol Withdrawal Syndrome , 2002, Substance abuse.

[13]  T. Palmstierna,et al.  A model for predicting alcohol withdrawal delirium. , 2001, Psychiatric services.

[14]  W. Hall,et al.  The alcohol withdrawal syndrome , 1997, The Lancet.

[15]  T. Wetterling,et al.  Clinical predictors of alcohol withdrawal delirium. , 1994, Alcoholism, clinical and experimental research.